1
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Lang BM, Zielbauer S, Stege H, Grabbe S, Staubach P. If patients had a choice - Treatment satisfaction and patients' preference in therapy of actinic keratoses. J Dtsch Dermatol Ges 2024. [PMID: 39171774 DOI: 10.1111/ddg.15457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 04/16/2024] [Indexed: 08/23/2024]
Abstract
BACKGROUND Actinic keratoses (AK) are increasing in incidence and represent the most common (pre-)cancerous lesion in the fair-skinned population, with a high unmet medical need. In order to increase treatment adherence, it is very important to assess patients' therapy-related evaluations of different treatment options. PATIENTS AND METHODS 100 patients with AK who were treated with at least two different treatment options were included. They rated their therapies using the Treatment Satisfaction Questionnaire for Medication (TSQM, maximum 100 points per category) and a Likert scale (LS, 1 = very satisfied; 6 = not satisfied). Patients were also asked about their needs in terms of treatment goal, cost, type, duration, and location of treatment. RESULTS 81% of the study participants were male and on average 74 years old. 95% had field cancerization. Eight frequently used therapy procedures were evaluated by the patients (surgery, cryotherapy, various topical agents, photodynamic therapy). The TSQM satisfaction scores ranged from 78.47 ± 16.07 (surgical procedures) to 53.03 ± 22.13 (diclofenac-HA). Statistically significant differences between the procedures were only found in the area of efficacy. Side effects were classified as low. Low recurrence rate and safe removal were the most important treatment goals (LS: 1.18 ± 0.44 and 1.27 ± 0.53, respectively). CONCLUSIONS Understanding patient preferences is essential for adherence and is therefore of great importance for the success of AK therapy. Personalized approaches should be considered in the choice of therapy.
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Affiliation(s)
- Berenice M Lang
- Department of Dermatology, University Medical Center Mainz, Mainz, Germany
| | | | - Henner Stege
- Department of Dermatology, University Medical Center Mainz, Mainz, Germany
| | - Stephan Grabbe
- Department of Dermatology, University Medical Center Mainz, Mainz, Germany
| | - Petra Staubach
- Department of Dermatology, University Medical Center Mainz, Mainz, Germany
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2
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DeTemple VK, Walter A, Bredemeier S, Gutzmer R, Schaper-Gerhardt K. Anti-tumor effects of tirbanibulin in squamous cell carcinoma cells are mediated via disruption of tubulin-polymerization. Arch Dermatol Res 2024; 316:341. [PMID: 38847867 PMCID: PMC11161541 DOI: 10.1007/s00403-024-03032-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Revised: 04/25/2024] [Accepted: 04/26/2024] [Indexed: 06/10/2024]
Abstract
Topical tirbanibulin is a highly effective and well tolerated novel treatment option for actinic keratoses (AKs). This study aimed to characterize the mode of action of tirbanibulin in keratinocytes (NHEK) and cutaneous squamous cell carcinoma (cSCC) cell lines (A431, SCC-12) in vitro. Tirbanibulin significantly reduced proliferation in a dose-dependent manner in all investigated cell lines, inhibited migration, and induced G2/M-cell cycle arrest only in the cSCC cell lines analyzed, and induced apoptosis solely in A431, which showed the highest sensitivity to tirbanibulin. In general, we detected low basal expression of phosphorylated SRC in all cell lines analyzed, therefore, interference with SRC signaling does not appear to be the driving force regarding the observed effects of tirbanibulin. The most prominent tirbanibulin-mediated effect was on β-tubulin-polymerization, which was especially impaired in A431. Additionally, tirbanibulin induced an increase of the proinflammatory cytokines IL-1α, bFGF and VEGF in A431. In conclusion, tirbanibulin mediated anti-tumor effects predominantly in A431, while healthy keratinocytes and more dedifferentiated SCC-12 were less influenced. These effects of tirbanibulin are most likely mediated via dysregulation of β-tubulin-polymerization and may be supported by proinflammatory aspects.
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Affiliation(s)
- Viola K DeTemple
- Universitätsklinik für Dermatologie, Venerologie, Allergologie und Phlebologie, Johannes Wesling Klinikum Minden, Universitätsklinik der Ruhr-Universität Bochum, Hans-Nolte-Straße 1, 32429, Minden, Germany.
| | - Antje Walter
- Klinik für Dermatologie, Allergologie und Venerologie, Hauttumorzentrum Hannover, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Sabine Bredemeier
- Universitätsklinik für Dermatologie, Venerologie, Allergologie und Phlebologie, Johannes Wesling Klinikum Minden, Universitätsklinik der Ruhr-Universität Bochum, Hans-Nolte-Straße 1, 32429, Minden, Germany
| | - Ralf Gutzmer
- Universitätsklinik für Dermatologie, Venerologie, Allergologie und Phlebologie, Johannes Wesling Klinikum Minden, Universitätsklinik der Ruhr-Universität Bochum, Hans-Nolte-Straße 1, 32429, Minden, Germany
| | - Katrin Schaper-Gerhardt
- Universitätsklinik für Dermatologie, Venerologie, Allergologie und Phlebologie, Johannes Wesling Klinikum Minden, Universitätsklinik der Ruhr-Universität Bochum, Hans-Nolte-Straße 1, 32429, Minden, Germany
- Klinik für Dermatologie, Allergologie und Venerologie, Hauttumorzentrum Hannover, Medizinische Hochschule Hannover, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
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3
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Kandolf L, Peris K, Malvehy J, Mosterd K, Heppt MV, Fargnoli MC, Berking C, Arenberger P, Bylaite-Bučinskiene M, Del Marmol V, Dirschka T, Dreno B, Forsea AM, Harwood CA, Hauschild A, Heerfordt IM, Kauffman R, Kelleners-Smeets N, Lallas A, Lebbe C, Leiter U, Longo C, Mijušković Ž, Pellacani G, Puig S, Saiag P, Šitum M, Stockfleth E, Salavastru C, Stratigos A, Zalaudek I, Garbe C. European consensus-based interdisciplinary guideline for diagnosis, treatment and prevention of actinic keratoses, epithelial UV-induced dysplasia and field cancerization on behalf of European Association of Dermato-Oncology, European Dermatology Forum, European Academy of Dermatology and Venereology and Union of Medical Specialists (Union Européenne des Médecins Spécialistes). J Eur Acad Dermatol Venereol 2024; 38:1024-1047. [PMID: 38451047 DOI: 10.1111/jdv.19897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 01/23/2024] [Indexed: 03/08/2024]
Abstract
A collaboration of multidisciplinary experts from the European Association of Dermato-Oncology, the European Dermatology Forum, the European Academy of Dermatology and Venereology, and the European Union of Medical Specialists was formed to develop European recommendations on AK diagnosis and treatment, based on current literature and expert consensus. This guideline addresses the epidemiology, diagnostics, risk stratification and treatments in immunocompetent as well as immunosuppressed patients. Actinic keratoses (AK) are potential precursors of cutaneous squamous cell carcinoma (cSCC) and display typical histopathologic and immunohistochemical features of this malignancy in an early stage. They can develop into cSSC in situ and become invasive in a low percentage of cases. AK is the most frequent neoplasia in white populations, frequently occurring within a cancerous field induced by ultraviolet radiation. Since it cannot be predicted, which lesion will progress to cSCC and when treatment is usually recommended. The diagnosis of AK and field cancerization is made by clinical examination. Dermatoscopy, confocal microscopy, optical coherence tomography or line-field confocal-OCT can help in the differential diagnosis of AK and other skin neoplasms. A biopsy is indicated in clinically and/or dermatoscopically suspicious and/or treatment-refractory lesions. The choice of treatment depends on patients' and lesion characteristics. For single non-hyperkeratotic lesions, the treatment can be started upon patient's request with destructive treatments or topical treatments. For multiple lesions, field cancerization treatment is advised with topical treatments and photodynamic therapy. Preventive measures such as sun protection, self-examination and repeated field cancerization treatments of previously affected skin areas in high-risk patients are advised.
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Affiliation(s)
- Lidija Kandolf
- Department of Dermatology, Faculty of Medicine, University of Defence, Military Medical Academy, Belgrade, Serbia
| | - Ketty Peris
- UOC di Dermatologia, Dipartimento di Scienze Mediche e Chirurgiche Addominali ed Endrocrino Metaboliche, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Rome, Italy
- Dermatologia, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Josep Malvehy
- Dermatology Department of Hospital Clinic of Barcelona, IDIBAPS, CIBER de Enfermedades Raras, Instituto Carlos III, University of Barcelona, Barcelona, Spain
| | - Klara Mosterd
- Department of Dermatology, Maastricht University Medical Centre+ Comprehensive Cancer Centre, Maastricht, The Netherlands
- GROW-School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
| | - Markus V Heppt
- Department of Dermatology, Uniklinikum Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
- Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CC ER-EMN), Erlangen, Germany
| | - Maria Concetta Fargnoli
- Dermatology, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Carola Berking
- Department of Dermatology, Uniklinikum Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
- Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CC ER-EMN), Erlangen, Germany
| | - Petr Arenberger
- Department of Dermatovenereology, Third Faculty of Medicine, Charles University and University Hospital of Kralovske Vinohrady, Prague, Czech Republic
| | - Matilda Bylaite-Bučinskiene
- Clinic of Infectious Diseases and Dermatovenereology, Centre of Dermatovenereology, Vilnius University, Vilnius, Lithuania
| | - Veronique Del Marmol
- Department of Dermatology, University Hospital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Thomas Dirschka
- Faculty of Health, University Witten-Herdecke, Witten, Germany
- CentroDerm Clinic, Wuppertal, Germany
| | - Brigitte Dreno
- Nantes Université, INSERM, CNRS, Immunology and New Concepts in ImmunoTherapy, INCIT, UMR 1302/EMR6001, Nantes, France
| | - Ana-Maria Forsea
- Department of Oncologic Dermatology, Elias University Hospital Bucharest, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Catherine A Harwood
- Centre for Cell Biology and Cutaneous Research, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Axel Hauschild
- Department of Dermatology, University Hospital (UKSH), Kiel, Germany
| | - Ida Marie Heerfordt
- Department of Dermatology, Copenhagen University Hospital - Bispebjerg and Frederiksberg, Copenhagen, Denmark
| | - Roland Kauffman
- Department of Dermatology, Venereology and Allergology, Frankfurt University Hospital, Frankfurt, Germany
| | - Nicole Kelleners-Smeets
- Department of Dermatology, Maastricht University Medical Centre+ Comprehensive Cancer Centre, Maastricht, The Netherlands
- GROW-School for Oncology and Reproduction, Maastricht University, Maastricht, The Netherlands
| | - Aimilios Lallas
- First Department of Dermatology, Aristotle University, Thessaloniki, Greece
| | - Celeste Lebbe
- Université Paris Cite, AP-HP Dermato-oncology, Cancer institute APHP, Nord Paris cité, INSERM U976, Saint Louis Hospital, Paris, France
| | - Ulrike Leiter
- Centre for Dermatooncology, Department of Dermatology, Eberhard Karls University, Tuebingen, Germany
| | - Caterina Longo
- Skin Cancer Center, Azienda Unità Sanitaria Locale - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Željko Mijušković
- Department of Dermatology, Faculty of Medicine, University of Defence, Military Medical Academy, Belgrade, Serbia
| | - Giovanni Pellacani
- Department of Dermatology, University of Modena and Reggio Emilia, Modena, Italy
| | - Susana Puig
- Dermatology Department of Hospital Clinic of Barcelona, IDIBAPS, CIBER de Enfermedades Raras, Instituto Carlos III, University of Barcelona, Barcelona, Spain
| | - Philippe Saiag
- Department of General and Oncologic Dermatology, Ambroise Paré Hospital, APHP, & EA 4340 "Biomarkers in Cancerology and Hemato-Oncology", UVSQ, Université Paris-Saclay, Boulogne-Billancourt, France
| | - Mirna Šitum
- Department of Dermatology and Venereology, Sestre Milosrdnice University Hospital Center, Zagreb, Croatia
| | - Eggert Stockfleth
- Skin Cancer Center, Department of Dermatology, Ruhr-University Bochum, Bochum, Germany
| | - Carmen Salavastru
- Department of Pediatric Dermatology, Colentina Clinical Hospital, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Alexander Stratigos
- 1st Department of Dermatology-Venereology, National and Kapodistrian University of Athens, Andreas Sygros Hospital, Athens, Greece
| | - Iris Zalaudek
- Dermatology Clinic, Maggiore Hospital, Department of Medical Sciences, University of Trieste, Trieste, Italy
| | - Claus Garbe
- Centre for Dermatooncology, Department of Dermatology, Eberhard Karls University, Tuebingen, Germany
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4
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Olesen UH, Foged C, Jacobsen K, Ortner VK, Fredman G, Paasch U, Haedersdal M. Line-field confocal optical coherence tomography for in vivo visualization of morphological characteristics of squamous cell carcinoma in a murine model. Lasers Surg Med 2024; 56:14-18. [PMID: 38129971 DOI: 10.1002/lsm.23750] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Revised: 12/05/2023] [Accepted: 12/07/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVES Non-invasive imaging with line-field confocal optical coherence tomography (LC-OCT) can support the diagnosis of squamous cell carcinoma (SCC) through visualization of morphological characteristics specific to skin cancer. We aimed to visualize prominent morphological characteristics of SCC using LC-OCT in a well-established murine SCC model. MATERIALS AND METHODS Nine hairless mice were exposed to ultraviolet radiation three times weekly for 9 months to induce SCC development. Visible SCC tumors (n = 9) were imaged with LC-OCT and the presence of 10 well-described morphological characteristics of SCC were evaluated in the scans by two physicians with adjudication by a third. RESULTS Overall, murine morphological characteristics resembled corresponding features previously reported in human SCCs. Interrupted dermal-epidermal junction occurred in 100% of tumors. In epidermis, the most frequently observed characteristics were severe epidermal dysplasia (100%) and tumor budding (89%). Common dermal characteristics included broad strands (100%) and collagen alterations (78%). CONCLUSION LC-OCT imaging can be used to non-invasively visualize morphological characteristics specific to SCC in an in vivo preclinical model.
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Affiliation(s)
- Uffe H Olesen
- Department of Dermatology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark
| | - Camilla Foged
- Department of Dermatology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark
| | - Kevin Jacobsen
- Department of Dermatology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark
| | - Vinzent K Ortner
- Department of Dermatology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark
| | - Gabriella Fredman
- Department of Dermatology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark
| | - Uwe Paasch
- Department of Dermatology, Venereology and Allergy, University of Leipzig, Leipzig, Germany
| | - Merete Haedersdal
- Department of Dermatology, Copenhagen University Hospital Bispebjerg, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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5
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Leiter U, Heppt MV, Steeb T, Alter M, Amaral T, Bauer A, Bechara FG, Becker JC, Breitbart EW, Breuninger H, Diepgen T, Dirschka T, Eigentler T, El Gammal AKS, Felcht M, Flaig MJ, Follmann M, Fritz K, Grabbe S, Greinert R, Gutzmer R, Hauschild A, Hillen U, Ihrler S, John SM, Kofler L, Koelbl O, Krause-Bergmann A, Kraywinkel K, Krohn S, Langer T, Loquai C, Löser CR, Mohr P, Nashan D, Nothacker M, Pfannenberg C, Salavastru C, Schmitz L, Stockfleth E, Szeimies RM, Ulrich C, Voelter-Mahlknecht S, Vordermark D, Weichenthal M, Welzel J, Wermker K, Wiegand S, Garbe C, Berking C. S3-Leitlinie "Aktinische Keratose und Plattenepithelkarzinom der Haut" - Update 2023, Teil 2: Epidemiologie und Ätiologie, Diagnostik, Therapie des invasiven Plattenepithelkarzinoms der Haut, Nachsorge und Prävention: S3 guideline "actinic keratosis and cutaneous squamous cell carcinoma" - update 2023, part 2: epidemiology and etiology, diagnostics, surgical and systemic treatment of cutaneous squamous cell carcinoma (cSCC), surveillance and prevention. J Dtsch Dermatol Ges 2023; 21:1422-1434. [PMID: 37946644 DOI: 10.1111/ddg.15256_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 08/18/2023] [Indexed: 11/12/2023]
Abstract
ZusammenfassungAktinische Keratosen (AK) sind häufige Hautveränderungen bei hellhäutigen Menschen mit dem Potenzial, in ein kutanes Plattenepithelkarzinom (PEK) überzugehen. Beide Erkrankungen können mit erheblicher Morbidität verbunden sein und stellen eine große Krankheitslast insbesondere in der älteren Bevölkerung dar. Um einen evidenzbasierten Rahmen für die klinische Entscheidungsfindung zu schaffen, wurde die S3‐Leitlinie "Aktinische Keratose und kutanes Plattenepithelkarzinom" aktualisiert und um die Themen Plattenepithelkarzinom in situ (Morbus Bowen) und Cheilitis actinica, die Manifestation der AK am Lippenrot, erweitert. Die Leitlinie richtet sich dabei an Dermatologen, Allgemeinmediziner, HNO‐Ärzte, Chirurgen, Onkologen, Radiologen und Strahlentherapeuten in Klinik und Praxis sowie an andere medizinische Fachgebiete, politische Entscheidungsträger und Versicherungsgesellschaften, die sich mit der Diagnose und Behandlung von Patienten mit nicht‐melanozytärem Hautkrebs befassen. Für Patienten und deren Angehörige existiert eine gesonderte Patientenleitlinie. In diesem Teil behandeln wir die Themen Epidemiologie und Ätiologie, Diagnostik, Therapie des invasiven Plattenepithelkarzinoms der Haut, Nachsorge und Prävention.
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Affiliation(s)
- Ulrike Leiter
- Zentrum für Dermatoonkologie, Universitäts-Hautklinik, Eberhard-Karls-Universität Tübingen
| | - Markus V Heppt
- Hautklinik, Uniklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen
- Comprehensive Cancer Center Europäische Metropolregion Erlangen-Nürnberg (CCC ER-EMN), Erlangen
| | - Theresa Steeb
- Hautklinik, Uniklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen
- Comprehensive Cancer Center Europäische Metropolregion Erlangen-Nürnberg (CCC ER-EMN), Erlangen
| | - Mareike Alter
- Universitätsklinik für Dermatologie, Allergologie, Venerologie und Phlebologie, Johannes Wesling Klinikum, Ruhr-Universität Bochum Campus Minden
| | - Teresa Amaral
- Zentrum für Dermatoonkologie, Universitäts-Hautklinik, Eberhard-Karls-Universität Tübingen
| | - Andrea Bauer
- Klinik und Poliklinik für Dermatologie, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden
| | - Falk G Bechara
- Klinik für Dermatologie, Venerologie und Allergologie, St. Josef-Hospital, Ruhr-Universität Bochum
| | - Jürgen C Becker
- Translationale Hautkrebsforschung (TSCR), DKTK Essen/Düsseldorf, Universitätsmedizin Essen
| | | | - Helmut Breuninger
- Zentrum für Dermatoonkologie, Universitäts-Hautklinik, Eberhard-Karls-Universität Tübingen
| | - Thomas Diepgen
- Institut für Klinische Sozialmedizin, Universität Heidelberg
| | | | - Thomas Eigentler
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin
| | | | - Moritz Felcht
- Zentrum für Dermatochirurgie, St. Josefskrankenhaus Heidelberg GmbH, Heidelberg
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsmedizin Mannheim
| | - Michael J Flaig
- Klinik und Poliklinik für Dermatologie und Allergologie, Klinikum der Universität München, LMU München
| | - Markus Follmann
- Leitlinienprogramm Onkologie, Deutsche Krebsgesellschaft e.V., Berlin
| | - Klaus Fritz
- Zentrum für Dermatologie, Laser und Ästhetische Medizin, Landau
| | - Stephan Grabbe
- Hautklinik der Universitätsmedizin, Johannes Gutenberg Universität Mainz
| | | | - Ralf Gutzmer
- Universitätsklinik für Dermatologie, Allergologie, Venerologie und Phlebologie, Johannes Wesling Klinikum, Ruhr-Universität Bochum Campus Minden
| | - Axel Hauschild
- Hautklinik, Universitätsklinikum Schleswig-Holstein, Campus Kiel
| | - Uwe Hillen
- Klinik für Dermatologie und Venerologie, Vivantes Klinikum Neukölln, Berlin
| | | | - Swen Malte John
- Abteilung Dermatologie und Umweltmedizin, Universität Osnabrück, Institut für interdisziplinäre Dermatologische Prävention und Rehabilitation (iDerm) an der Universität Osnabrück
| | - Lukas Kofler
- Studienzentrum Operative Dermatologie, Universitäts-Hautklinik, Eberhard-Karls-Universität, Tübingen
| | - Oliver Koelbl
- Klinik und Poliklinik für Strahlentherapie, Universitätsklinikum Regensburg
| | - Albrecht Krause-Bergmann
- Klinik für Unfall- und Wiederherstellungschirurgie, Orthopädie, Plastische-, Ästhetische- und Handchirurgie, Sektion für Plastische-, Ästhetische- und Handchirurgie, Gütersloh
| | | | - Steffen Krohn
- Deutsche Gesetzliche Unfallversicherung e.V. (DGUV), Berlin
| | - Thomas Langer
- Leitlinienprogramm Onkologie, Deutsche Krebsgesellschaft e.V., Berlin
| | - Carmen Loquai
- Klinikum Bremen-Ost, Klinik für Dermatologie, Dermatochirurgie, Dermatoonkologie und Allergologie, Hautkrebszentrum Bremen
| | - Christoph R Löser
- Hautklinik, Hauttumorzentrum, Klinikum Ludwigshafen gGmbH, Ludwigshafen
| | - Peter Mohr
- Elbe Kliniken Stade Buxtehude, Klinikum Buxtehude
| | | | - Monika Nothacker
- Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF), Institut für Medizinisches Wissensmanagement, c/o Philipps Universität Marburg
| | - Christina Pfannenberg
- Klinik für Diagnostische und Interventionelle Radiologie, Eberhard-Karls-Universität Tübingen
| | - Carmen Salavastru
- Klinik für Kinderdermatologie, Onkologische Dermatologie - Forschungseinheit, Colentina Universitätsklinikum, Bucharest, "Carol Davila" Universitätsmedizin, Bukarest, Rumänien
| | - Lutz Schmitz
- CentroDerm Wuppertal, Heinz-Fangman-Straße 57, Wuppertal
| | - Eggert Stockfleth
- Klinik für Dermatologie, Venerologie und Allergologie, St. Josef-Hospital, Ruhr-Universität Bochum
| | | | | | - Susanne Voelter-Mahlknecht
- Institut für Arbeitsmedizin, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin
| | - Dirk Vordermark
- Universitätsklinik für Strahlentherapie, Martin-Luther-Universität Halle-Wittenberg, Halle/Saale
| | | | - Julia Welzel
- Klinik für Dermatologie und Allergologie, Universitätsklinikum Augsburg Medizincampus Süd, Augsburg
| | - Kai Wermker
- Klinik für Mund-, Kiefer- und Gesichtschirurgie, Plastische und Ästhetische Operationen, Klinikum Osnabrück
| | - Susanne Wiegand
- Klinik und Poliklinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Leipzig
| | - Claus Garbe
- Zentrum für Dermatoonkologie, Universitäts-Hautklinik, Eberhard-Karls-Universität Tübingen
| | - Carola Berking
- Hautklinik, Uniklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen
- Comprehensive Cancer Center Europäische Metropolregion Erlangen-Nürnberg (CCC ER-EMN), Erlangen
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6
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Leiter U, Heppt MV, Steeb T, Alter M, Amaral T, Bauer A, Bechara FG, Becker JC, Breitbart EW, Breuninger H, Diepgen T, Dirschka T, Eigentler T, ElGammal AKS, Felcht M, Flaig MJ, Follmann M, Fritz K, Grabbe S, Greinert R, Gutzmer R, Hauschild A, Hillen U, Ihrler S, John SM, Kofler L, Koelbl O, Krause-Bergmann A, Kraywinkel K, Krohn S, Langer T, Loquai C, Löser CR, Mohr P, Nashan D, Nothacker M, Pfannenberg C, Salavastru C, Schmitz L, Stockfleth E, Szeimies RM, Ulrich C, Voelter-Mahlknecht S, Vordermark D, Weichenthal M, Welzel J, Wermker K, Wiegand S, Garbe C, Berking C. S3 guideline "actinic keratosis and cutaneous squamous cell carcinoma" - update 2023, part 2: epidemiology and etiology, diagnostics, surgical and systemic treatment of cutaneous squamous cell carcinoma (cSCC), surveillance and prevention. J Dtsch Dermatol Ges 2023; 21:1422-1433. [PMID: 37840404 DOI: 10.1111/ddg.15256] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 08/18/2023] [Indexed: 10/17/2023]
Abstract
Actinic keratosis (AK) are common lesions in light-skinned individuals that can potentially progress to cutaneous squamous cell carcinoma (cSCC). Both conditions may be associated with significant morbidity and constitute a major disease burden, especially among the elderly. To establish an evidence-based framework for clinical decision making, the guideline "actinic keratosis and cutaneous squamous cell carcinoma" was updated and expanded by the topics cutaneous squamous cell carcinoma in situ (Bowen's disease) and actinic cheilitis. The guideline is aimed at dermatologists, general practitioners, ear nose and throat specialists, surgeons, oncologists, radiologists and radiation oncologists in hospitals and office-based settings, as well as other medical specialties, policy makers and insurance funds involved in the diagnosis and treatment of patients with AK and cSCC. A separate guideline exists for patients and their relatives. In this part, we will address aspects relating to epidemiology and etiology, diagnostics, surgical and systemic treatment of cutaneous squamous cell carcinoma (cSCC), surveillance and prevention.
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Affiliation(s)
- Ulrike Leiter
- Center of Dermatooncology, University Department of Dermatooncology, Eberhard-Karls-University Tuebingen, Tübingen, Germany
| | - Markus V Heppt
- Department of Dermatology, Uniklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
- Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuernberg, (CCC ER-EMN), Erlangen, Germany
| | - Theresa Steeb
- Department of Dermatology, Uniklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
- Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuernberg, (CCC ER-EMN), Erlangen, Germany
| | - Mareike Alter
- Department of Dermatology, Johannes Wesling Medical Center, Ruhr University Bochum Campus Minden, Minden, Germany
| | - Teresa Amaral
- Center of Dermatooncology, University Department of Dermatooncology, Eberhard-Karls-University Tuebingen, Tübingen, Germany
| | - Andrea Bauer
- Department of Dermatology, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - Falk G Bechara
- Department of Dermatology, Venerology, and Allergology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Jürgen C Becker
- Translational Skin Cancer Research (TSCR), DKTK Essen/Düsseldorf, University Medicine Essen, Essen, Germany
| | | | - Helmut Breuninger
- Center of Dermatooncology, University Department of Dermatooncology, Eberhard-Karls-University Tuebingen, Tübingen, Germany
| | - Thomas Diepgen
- Institute of Clinical Social Medicine, University Heidelberg, Heidelberg, Germany
| | | | - Thomas Eigentler
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
| | | | - Moritz Felcht
- Department of Dermatosurgery, St. Josefhospital Heidelberg GmbH, Heidelberg, Germany
- Department of Dermatology, Venereology und Allergy, University Medicine Mannheim, Mannheim, Germany
| | - Michael J Flaig
- Department of Dermatology and Allergy, University Hospital, LMU Munich, München, Germany
| | - Markus Follmann
- German Guideline Program in Oncology, German Cancer Society, Berlin, Germany
| | - Klaus Fritz
- Dermatology and Laser Consultation Center, Landau, Germany
| | - Stephan Grabbe
- Department of Dermatology, Mainz University Medical School, Mainz, Germany
| | - Rüdiger Greinert
- Elbe Clinics Stade Buxtehude GmbH, Medical Center Buxtehude, Buxtehude, Germany
| | - Ralf Gutzmer
- Department of Dermatology, Johannes Wesling Medical Center, Ruhr University Bochum Campus Minden, Minden, Germany
| | - Axel Hauschild
- Department of Dermatology, University Hospital Schleswig-Holstein Campus Kiel, Kiel, Germany
| | - Uwe Hillen
- Department of Dermatology & Venerology, Vivantes Hospital Neukölln, Berlin, Germany
| | | | - Swen Malte John
- Department of Dermatology and Environmental Medicine, University of Osnabrueck, Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) at the University of Osnabrueck, Osnabrück, Germany
| | - Lukas Kofler
- Study Center for Dermatosurgery, University Hospital Tuebingen, Eberhard-Karls-University, Tübingen, Germany
| | - Oliver Koelbl
- Clinic and Polyclinic for Radiooncology, University Medical Center Regensburg, Regensburg, Germany
| | - Albrecht Krause-Bergmann
- Clinic for Trauma-, Orthopedics-, and Plastic Surgery, Department for Plastic-, Aesthetic- and Handsurgery, Gütersloh, Germany
| | | | - Steffen Krohn
- German Social Accident Insurance (DGUV), Berlin, Germany
| | - Thomas Langer
- German Guideline Program in Oncology, German Cancer Society, Berlin, Germany
| | - Carmen Loquai
- Department of Dermatology, Medical Center Bremen-Ost, Bremen, Germany
| | - Christoph R Löser
- Skin Hospital, Skin Cancer Center, Ludwigshafen Hospital, Ludwigshafen, Germany
| | - Peter Mohr
- Elbe Clinics Stade Buxtehude GmbH, Medical Center Buxtehude, Buxtehude, Germany
| | - Dorothée Nashan
- Department of Dermatology, Klinikum Dortmund, Dortmund, Germany
| | - Monika Nothacker
- Association of the Scientific Medical Societies in Germany (AWMF), Institute for Medical Knowledge Management, c/o Philipps Universität Marburg, Marburg, Germany
| | - Christina Pfannenberg
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University Tuebingen, Tübingen, Germany
| | - Carmen Salavastru
- Pediatric Dermatology Discipline, Dermato-oncology Research Facility, "Colentina" Clinical Hospital, Bucharest 020125, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Rumania
| | | | - Eggert Stockfleth
- Department of Dermatology, Venerology, and Allergology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Rolf-Markus Szeimies
- Department of Dermatology and Allergology, Klinikum Vest GmbH, Recklinghausen, Germany
| | - Claas Ulrich
- Dermatologie am Regierungsviertel, Berlin, Germany
| | - Susanne Voelter-Mahlknecht
- Institute of Occupational Medicine, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
| | - Dirk Vordermark
- Department of Radiation Oncology, Martin-Luther-University Halle-Wittenberg, Halle/Saale, Germany
| | - Michael Weichenthal
- Department of Dermatology, University Hospital Schleswig-Holstein Campus Kiel, Kiel, Germany
| | - Julia Welzel
- Department of Dermatology, University Hospital Augsburg, Augsburg, Germany
| | - Kai Wermker
- Klinikum Osnabrueck, Department for Oral and Maxillofacial Surgery, Plastic and Aesthetic Operations, Osnabrück, Germany
| | - Susanne Wiegand
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Claus Garbe
- Center of Dermatooncology, University Department of Dermatooncology, Eberhard-Karls-University Tuebingen, Tübingen, Germany
| | - Carola Berking
- Department of Dermatology, Uniklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
- Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuernberg, (CCC ER-EMN), Erlangen, Germany
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7
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Heppt MV, Leiter U, Steeb T, Alter M, Amaral T, Bauer A, Bechara FG, Becker JC, Breitbart EW, Breuninger H, Diepgen T, Dirschka T, Eigentler T, El Gammal AKS, Felcht M, Flaig MJ, Follmann M, Fritz K, Grabbe S, Greinert R, Gutzmer R, Hauschild A, Hillen U, Ihrler S, John SM, Kofler L, Koelbl O, Krause-Bergmann A, Kraywinkel K, Krohn S, Langer T, Loquai C, Löser CR, Mohr P, Nashan D, Nothacker M, Pfannenberg C, Salavastru C, Schmitz L, Stockfleth E, Szeimies RM, Ulrich C, Voelter-Mahlknecht S, Vordermark D, Weichenthal M, Welzel J, Wermker K, Wiegand S, Garbe C, Berking C. S3-Leitlinie "Aktinische Keratose und Plattenepithelkarzinom der Haut" - Update 2023, Teil 1: Therapie der aktinischen Keratose, Morbus Bowen, Cheilitis actinica, berufsbedingte Erkrankung und Versorgungsstrukturen: S3 guideline "actinic keratosis and cutaneous squamous cell carcinoma"- update 2023, part 1: treatment of actinic keratosis, actinic cheilitis, cutaneous squamous cell carcinoma in situ (Bowen's disease), occupational disease and structures of care. J Dtsch Dermatol Ges 2023; 21:1249-1262. [PMID: 37845050 DOI: 10.1111/ddg.15231_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 07/27/2023] [Indexed: 10/18/2023]
Abstract
ZusammenfassungAktinische Keratosen (AK) sind häufige Hautveränderungen bei hellhäutigen Menschen mit dem Potenzial, in ein kutanes Plattenepithelkarzinom (PEK) überzugehen. Beide Erkrankungen können mit erheblicher Morbidität verbunden sein und stellen eine große Krankheitslast insbesondere in der älteren Bevölkerung dar. Um eine evidenzbasierte Grundlage für die klinische Entscheidungsfindung zu schaffen, wurde die S3‐Leitlinie „Aktinische Keratose und kutanes Plattenepithelkarzinom“ aktualisiert und um die Themen Plattenepithelkarzinom in situ (Morbus Bowen) und Cheilitis actinica, die Manifestation der AK am Lippenrot, erweitert. Die Leitlinie richtet sich dabei an Dermatologen, Allgemeinmediziner, HNO‐Ärzte, Chirurgen, Onkologen, Radiologen und Strahlentherapeuten in Klinik und Praxis sowie an andere medizinische Fachgebiete, politische Entscheidungsträger und Versicherungsgesellschaften, die sich mit der Diagnose und Behandlung von Patienten mit nichtmelanozytärem Hautkrebs befassen. Für Patienten und deren Angehörige existiert eine gesonderte Patientenleitlinie. In diesem Teil behandeln wir die Themen Therapie der aktinischen Keratose, Morbus Bowen, Cheilitis actinica, berufsbedingte Erkrankung an AK und PEK sowie Versorgungsstrukturen.
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Affiliation(s)
- Markus V Heppt
- Hautklinik, Uniklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen
- Comprehensive Cancer Center Europäische Metropolregion Erlangen-Nürnberg (CCC ER-EMN), Erlangen
| | - Ulrike Leiter
- Zentrum für Dermatoonkologie, Universitäts-Hautklinik, Eberhard-Karls-Universität Tübingen
| | - Theresa Steeb
- Hautklinik, Uniklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen
- Comprehensive Cancer Center Europäische Metropolregion Erlangen-Nürnberg (CCC ER-EMN), Erlangen
| | - Mareike Alter
- Universitätsklinik für Dermatologie, Allergologie, Venerologie und Phlebologie, Johannes Wesling Klinikum, Ruhr-Universität Bochum Campus Minden
| | - Teresa Amaral
- Zentrum für Dermatoonkologie, Universitäts-Hautklinik, Eberhard-Karls-Universität Tübingen
| | - Andrea Bauer
- Klinik und Poliklinik für Dermatologie, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden
| | - Falk G Bechara
- Klinik für Dermatologie, Venerologie und Allergologie, St. Josef-Hospital, Ruhr-Universität Bochum
| | - Jürgen C Becker
- Translationale Hautkrebsforschung (TSCR), DKTK Essen/Düsseldorf, Universitätsmedizin Essen
| | | | - Helmut Breuninger
- Zentrum für Dermatoonkologie, Universitäts-Hautklinik, Eberhard-Karls-Universität Tübingen
| | - Thomas Diepgen
- Institut für Klinische Sozialmedizin, Universität Heidelberg
| | | | - Thomas Eigentler
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin
| | | | - Moritz Felcht
- Zentrum für Dermatochirurgie, St. Josefskrankenhaus Heidelberg GmbH, Heidelberg
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsmedizin Mannheim
| | - Michael J Flaig
- Klinik und Poliklinik für Dermatologie und Allergologie, Klinikum der Universität München, LMU München
| | - Markus Follmann
- Leitlinienprogramm Onkologie, Deutsche Krebsgesellschaft e.V., Berlin
| | - Klaus Fritz
- Zentrum für Dermatologie, Laser und Ästhetische Medizin, Landau
| | - Stephan Grabbe
- Hautklinik der Universitätsmedizin, Johannes Gutenberg Universität Mainz
| | | | - Ralf Gutzmer
- Universitätsklinik für Dermatologie, Allergologie, Venerologie und Phlebologie, Johannes Wesling Klinikum, Ruhr-Universität Bochum Campus Minden
| | - Axel Hauschild
- Hautklinik, Universitätsklinikum Schleswig-Holstein, Campus Kiel
| | - Uwe Hillen
- Klinik für Dermatologie und Venerologie, Vivantes Klinikum Neukölln, Berlin
| | | | - Swen Malte John
- Abteilung Dermatologie und Umweltmedizin, Universität Osnabrück, Institut für interdisziplinäre Dermatologische Prävention und Rehabilitation (iDerm) an der Universität Osnabrück
| | - Lukas Kofler
- Studienzentrum Operative Dermatologie, Universitäts-Hautklinik, Eberhard-Karls-Universität, Tübingen
| | - Oliver Koelbl
- Klinik und Poliklinik für Strahlentherapie, Universitätsklinikum Regensburg
| | - Albrecht Krause-Bergmann
- Klinik für Unfall- und Wiederherstellungschirurgie, Orthopädie, Plastische-, Ästhetische- und Handchirurgie, Sektion für Plastische-, Ästhetische- und Handchirurgie, Gütersloh
| | | | - Steffen Krohn
- Deutsche Gesetzliche Unfallversicherung e.V. (DGUV), Berlin
| | - Thomas Langer
- Leitlinienprogramm Onkologie, Deutsche Krebsgesellschaft e.V., Berlin
| | - Carmen Loquai
- Klinikum Bremen-Ost, Klinik für Dermatologie, Dermatochirurgie, Dermatoonkologie und Allergologie, Hautkrebszentrum Bremen
| | - Christoph R Löser
- Hautklinik, Hauttumorzentrum, Klinikum Ludwigshafen gGmbH, Ludwigshafen
| | - Peter Mohr
- Elbe Kliniken Stade Buxtehude, Klinikum Buxtehude
| | | | - Monika Nothacker
- Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF), Institut für Medizinisches Wissensmanagement, c/o Philipps Universität Marburg
| | - Christina Pfannenberg
- Klinik für Diagnostische und Interventionelle Radiologie, Eberhard-Karls-Universität Tübingen
| | - Carmen Salavastru
- Klinik für Kinderdermatologie, Onkologische Dermatologie - Forschungseinheit, Colentina Universitätsklinikum, "Carol Davila" Universitätsmedizin, Bucharest, Bukarest, Rumänien
| | - Lutz Schmitz
- CentroDerm Wuppertal, Heinz-Fangman-Straße 57, Wuppertal
| | - Eggert Stockfleth
- Klinik für Dermatologie, Venerologie und Allergologie, St. Josef-Hospital, Ruhr-Universität Bochum
| | | | | | - Susanne Voelter-Mahlknecht
- Institut für Arbeitsmedizin, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin
| | - Dirk Vordermark
- Universitätsklinik für Strahlentherapie, Martin-Luther-Universität Halle-Wittenberg, Halle/Saale
| | | | - Julia Welzel
- Klinik für Dermatologie und Allergologie, Universitätsklinikum Augsburg Medizincampus Süd, Augsburg
| | - Kai Wermker
- Klinik für Mund-, Kiefer- und Gesichtschirurgie, Plastische und Ästhetische Operationen, Klinikum Osnabrück
| | - Susanne Wiegand
- Klinik und Poliklinik für Hals-, Nasen- und Ohrenheilkunde, Universitätsklinikum Leipzig
| | - Claus Garbe
- Zentrum für Dermatoonkologie, Universitäts-Hautklinik, Eberhard-Karls-Universität Tübingen
| | - Carola Berking
- Hautklinik, Uniklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen
- Comprehensive Cancer Center Europäische Metropolregion Erlangen-Nürnberg (CCC ER-EMN), Erlangen
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8
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Heppt MV, Leiter U, Steeb T, Alter M, Amaral T, Bauer A, Bechara FG, Becker JC, Breitbart EW, Breuninger H, Diepgen T, Dirschka T, Eigentler T, El Gammal AKS, Felcht M, Flaig MJ, Follmann M, Fritz K, Grabbe S, Greinert R, Gutzmer R, Hauschild A, Hillen U, Ihrler S, John SM, Kofler L, Koelbl O, Krause-Bergmann A, Kraywinkel K, Krohn S, Langer T, Loquai C, Löser CR, Mohr P, Nashan D, Nothacker M, Pfannenberg C, Salavastru C, Schmitz L, Stockfleth E, Szeimies RM, Ulrich C, Voelter-Mahlknecht S, Vordermark D, Weichenthal M, Welzel J, Wermker K, Wiegand S, Garbe C, Berking C. S3 guideline "actinic keratosis and cutaneous squamous cell carcinoma"- update 2023, part 1: treatment of actinic keratosis, actinic cheilitis, cutaneous squamous cell carcinoma in situ (Bowen's disease), occupational disease and structures of care. J Dtsch Dermatol Ges 2023; 21:1249-1262. [PMID: 37845077 DOI: 10.1111/ddg.15231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 07/27/2023] [Indexed: 10/18/2023]
Abstract
SummaryActinic keratosis (AK) are common lesions in light‐skinned individuals that can potentially progress to cutaneous squamous cell carcinoma (cSCC). Both conditions may be associated with significant morbidity and constitute a major disease burden, especially among the elderly. To establish an evidence‐based framework for clinical decision making, the guideline “actinic keratosis and cutaneous squamous cell carcinoma” was updated and expanded by the topics cutaneous squamous cell carcinoma in situ (Bowen's disease) and actinic cheilitis. The guideline is aimed at dermatologists, general practitioners, ear nose and throat specialists, surgeons, oncologists, radiologists and radiation oncologists in hospitals and office‐based settings, as well as other medical specialties, policy makers and insurance funds involved in the diagnosis and treatment of patients with AK and cSCC. A separate guideline exists for patients and their relatives. In this part, we will address aspects relating to AK, actinic cheilitis, Bowen's disease, occupational disease and care structures.
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Affiliation(s)
- Markus V Heppt
- Department of Dermatology, Uniklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
- Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuernberg, (CCC ER-EMN), Erlangen, Germany
| | - Ulrike Leiter
- Center of Dermatooncology, University Department of Dermatooncology, Eberhard-Karls-University Tuebingen, Tübingen, Germany
| | - Theresa Steeb
- Department of Dermatology, Uniklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
- Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuernberg, (CCC ER-EMN), Erlangen, Germany
| | - Mareike Alter
- Department of Dermatology, Johannes Wesling Medical Center, Ruhr University Bochum Campus Minden, Minden, Germany
| | - Teresa Amaral
- Center of Dermatooncology, University Department of Dermatooncology, Eberhard-Karls-University Tuebingen, Tübingen, Germany
| | - Andrea Bauer
- Department of Dermatology, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany
| | - Falk G Bechara
- Department of Dermatology, Venerology, and Allergology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Jürgen C Becker
- Translational Skin Cancer Research (TSCR), DKTK Essen/Düsseldorf, University Medicine Essen, Essen, Germany
| | | | - Helmut Breuninger
- Center of Dermatooncology, University Department of Dermatooncology, Eberhard-Karls-University Tuebingen, Tübingen, Germany
| | - Thomas Diepgen
- Institute of Clinical Social Medicine, University Heidelberg, Heidelberg, Germany
| | | | - Thomas Eigentler
- Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
| | | | - Moritz Felcht
- Department of Dermatosurgery, St. Josefhospital Heidelberg GmbH, Heidelberg, Germany
- Department of Dermatology, Venereology und Allergy, University Medicine Mannheim, Mannheim, Germany
| | - Michael J Flaig
- Department of Dermatology and Allergy, University Hospital, LMU Munich, München, Germany
| | - Markus Follmann
- German Guideline Program in Oncology, German Cancer Society, Berlin, Germany
| | - Klaus Fritz
- Dermatology and Laser Consultation Center, Landau, Germany
| | - Stephan Grabbe
- Department of Dermatology, Mainz University Medical School, Mainz, Germany
| | - Rüdiger Greinert
- Elbe Clinics Stade Buxtehude GmbH, Medical Center Buxtehude, Buxtehude, Germany
| | - Ralf Gutzmer
- Department of Dermatology, Johannes Wesling Medical Center, Ruhr University Bochum Campus Minden, Minden, Germany
| | - Axel Hauschild
- Department of Dermatology, University Hospital Schleswig-Holstein Campus Kiel, Kiel, Germany
| | - Uwe Hillen
- Department of Dermatology & Venerology, Vivantes Hospital Neukölln, Berlin, Germany
| | | | - Swen Malte John
- Department of Dermatology and Environmental Medicine, University of Osnabrueck, Institute for Interdisciplinary Dermatological Prevention and Rehabilitation (iDerm) at the University of Osnabrueck, Osnabrück, Germany
| | - Lukas Kofler
- Study Center for Dermatosurgery, University Hospital Tuebingen, Eberhard-Karls-University, Tübingen, Germany
| | - Oliver Koelbl
- Clinic and Polyclinic for Radiooncology, University Medical Center Regensburg, Regensburg, Germany
| | - Albrecht Krause-Bergmann
- Clinic for Trauma-, Orthopedics-, and Plastic Surgery, Department for Plastic-, Aesthetic- and Handsurgery, Gütersloh, Germany
| | | | - Steffen Krohn
- German Social Accident Insurance (DGUV), Berlin, Germany
| | - Thomas Langer
- German Guideline Program in Oncology, German Cancer Society, Berlin, Germany
| | - Carmen Loquai
- Department of Dermatology, Medical Center Bremen-Ost, Bremen, Germany
| | - Christoph R Löser
- Skin Hospital, Skin Cancer Center, Ludwigshafen Hospital, Ludwigshafen, Germany
| | - Peter Mohr
- Elbe Clinics Stade Buxtehude GmbH, Medical Center Buxtehude, Buxtehude, Germany
| | - Dorothée Nashan
- Department of Dermatology, Klinikum Dortmund, Dortmund, Germany
| | - Monika Nothacker
- Association of the Scientific Medical Societies in Germany (AWMF), Institute for Medical Knowledge Management, c/o Philipps Universität Marburg, Marburg, Germany
| | - Christina Pfannenberg
- Department of Diagnostic and Interventional Radiology, Eberhard-Karls-University Tuebingen, Tübingen, Germany
| | - Carmen Salavastru
- Pediatric Dermatology Discipline, Dermato-oncology Research Facility, "Colentina" Clinical Hospital, Bucharest 020125, "Carol Davila" University of Medicine and Pharmacy, Bucharest, Rumania
| | | | - Eggert Stockfleth
- Department of Dermatology, Venerology, and Allergology, St. Josef-Hospital, Ruhr-University Bochum, Bochum, Germany
| | - Rolf-Markus Szeimies
- Department of Dermatology and Allergology, Klinikum Vest GmbH, Recklinghausen, Germany
| | - Claas Ulrich
- Dermatologie am Regierungsviertel, Berlin, Germany
| | - Susanne Voelter-Mahlknecht
- Institute of Occupational Medicine, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt Universität zu Berlin, Berlin, Germany
| | - Dirk Vordermark
- Department of Radiation Oncology, Martin-Luther-University Halle-Wittenberg, Halle/Saale, Germany
| | - Michael Weichenthal
- Department of Dermatology, University Hospital Schleswig-Holstein Campus Kiel, Kiel, Germany
| | - Julia Welzel
- Department of Dermatology, University Hospital Augsburg, Augsburg, Germany
| | - Kai Wermker
- Klinikum Osnabrueck, Department for Oral and Maxillofacial Surgery, Plastic and Aesthetic Operations, Osnabrück, Germany
| | - Susanne Wiegand
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Leipzig, Leipzig, Germany
| | - Claus Garbe
- Center of Dermatooncology, University Department of Dermatooncology, Eberhard-Karls-University Tuebingen, Tübingen, Germany
| | - Carola Berking
- Department of Dermatology, Uniklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
- Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuernberg, (CCC ER-EMN), Erlangen, Germany
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9
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Balakirski G, Sabulyte S, Wesselmann U, Michalowitz AL, Kreuter A, Hofmann SC. Long-term effects of the COVID-19 pandemic on cutaneous squamous cell carcinoma: Increase of thick tumors in two german dermatology clinics. J Dtsch Dermatol Ges 2023; 21:910-913. [PMID: 37186057 DOI: 10.1111/ddg.15087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Accepted: 03/10/2023] [Indexed: 05/17/2023]
Affiliation(s)
- Galina Balakirski
- Center for Dermatology, Allergology and Dermatosurgery, Helios University Hospital Wuppertal, University of Witten/Herdecke, Wuppertal, Germany
| | - Simona Sabulyte
- Center for Dermatology, Allergology and Dermatosurgery, Helios University Hospital Wuppertal, University of Witten/Herdecke, Wuppertal, Germany
| | - Ulrich Wesselmann
- Center for Dermatology, Allergology and Dermatosurgery, Helios University Hospital Wuppertal, University of Witten/Herdecke, Wuppertal, Germany
| | - Alena-Lioba Michalowitz
- Department of Dermatology, Venereology and Allergology, Helios St. Elisabeth Hospital Oberhausen, University of Witten/Herdecke, Oberhausen, Germany
| | - Alexander Kreuter
- Department of Dermatology, Venereology and Allergology, Helios St. Elisabeth Hospital Oberhausen, University of Witten/Herdecke, Oberhausen, Germany
| | - Silke C Hofmann
- Center for Dermatology, Allergology and Dermatosurgery, Helios University Hospital Wuppertal, University of Witten/Herdecke, Wuppertal, Germany
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Balakirski G, Sabulyte S, Wesselmann U, Michalowitz AL, Kreuter A, Hofmann SC. Langzeitauswirkungen der COVID-19-Pandemie auf Plattenepithelkarzinome der Haut: Zunahme von dicken Tumoren in zwei deutschen Hautkliniken. J Dtsch Dermatol Ges 2023; 21:910-913. [PMID: 37574681 DOI: 10.1111/ddg.15087_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2022] [Accepted: 03/10/2023] [Indexed: 08/15/2023]
Affiliation(s)
- Galina Balakirski
- Zentrum für Dermatologie, Allergologie und Dermatochirurgie, Helios Universitätsklinikum Wuppertal, Universität Witten/Herdecke, Wuppertal, Deutschland
| | - Simona Sabulyte
- Zentrum für Dermatologie, Allergologie und Dermatochirurgie, Helios Universitätsklinikum Wuppertal, Universität Witten/Herdecke, Wuppertal, Deutschland
| | - Ulrich Wesselmann
- Zentrum für Dermatologie, Allergologie und Dermatochirurgie, Helios Universitätsklinikum Wuppertal, Universität Witten/Herdecke, Wuppertal, Deutschland
| | - Alena-Lioba Michalowitz
- Klinik für Dermatologie, Venerologie und Allergologie, Helios St. Elisabeth Klinik Oberhausen, Universität Witten/Herdecke, Oberhausen, Deutschland
| | - Alexander Kreuter
- Klinik für Dermatologie, Venerologie und Allergologie, Helios St. Elisabeth Klinik Oberhausen, Universität Witten/Herdecke, Oberhausen, Deutschland
| | - Silke C Hofmann
- Zentrum für Dermatologie, Allergologie und Dermatochirurgie, Helios Universitätsklinikum Wuppertal, Universität Witten/Herdecke, Wuppertal, Deutschland
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11
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Spanos S, Singh N, Laginha BI, Arnolda G, Wilkinson D, Smith AL, Cust AE, Braithwaite J, Rapport F. Measuring the quality of skin cancer management in primary care: A scoping review. Australas J Dermatol 2023; 64:177-193. [PMID: 36960976 PMCID: PMC10952799 DOI: 10.1111/ajd.14023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 03/02/2023] [Accepted: 03/07/2023] [Indexed: 03/25/2023]
Abstract
Skin cancer is a growing global problem and a significant health and economic burden. Despite the practical necessity for skin cancer to be managed in primary care settings, little is known about how quality of care is or should be measured in this setting. This scoping review aimed to capture the breadth and range of contemporary evidence related to the measurement of quality in skin cancer management in primary care settings. Six databases were searched for relevant texts reporting on quality measurement in primary care skin cancer management. Data from 46 texts published since 2011 were extracted, and quality measures were catalogued according to the three domains of the Donabedian model of healthcare quality (structure, process and outcome). Quality measures within each domain were inductively analysed into 13 key emergent groups. These represented what were deemed to be the most relevant components of skin cancer management as related to structure, process or outcomes measurement. Four groups related to the structural elements of care provision (e.g. diagnostic tools and equipment), five related to the process of care delivery (e.g. diagnostic processes) and four related to the outcomes of care (e.g. poor treatment outcomes). A broad range of quality measures have been documented, based predominantly on articles using retrospective cohort designs; systematic reviews and randomised controlled trials were limited.
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Affiliation(s)
- Samantha Spanos
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Faculty of Medicine, Health and Human SciencesMacquarie UniversitySydneyNew South WalesAustralia
| | - Nehal Singh
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Faculty of Medicine, Health and Human SciencesMacquarie UniversitySydneyNew South WalesAustralia
| | - Bela I. Laginha
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Faculty of Medicine, Health and Human SciencesMacquarie UniversitySydneyNew South WalesAustralia
| | - Gaston Arnolda
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Faculty of Medicine, Health and Human SciencesMacquarie UniversitySydneyNew South WalesAustralia
| | - David Wilkinson
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Faculty of Medicine, Health and Human SciencesMacquarie UniversitySydneyNew South WalesAustralia
- National Skin Cancer CentresSouth BrisbaneQueenslandAustralia
| | - Andrea L. Smith
- The Daffodil CentreUniversity of Sydney, a joint venture with Cancer Council NSWSydneyNew South WalesAustralia
| | - Anne E. Cust
- The Daffodil CentreUniversity of Sydney, a joint venture with Cancer Council NSWSydneyNew South WalesAustralia
- Melanoma Institute AustraliaThe University of SydneySydneyNew South WalesAustralia
| | - Jeffrey Braithwaite
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Faculty of Medicine, Health and Human SciencesMacquarie UniversitySydneyNew South WalesAustralia
| | - Frances Rapport
- Centre for Healthcare Resilience and Implementation Science, Australian Institute of Health Innovation, Faculty of Medicine, Health and Human SciencesMacquarie UniversitySydneyNew South WalesAustralia
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12
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Chatzikonstantinou G, Diefenhardt M, Fleischmann M, Meissner M, Scherf C, Trommel M, Ramm U, Rödel C, Tselis N, Licher J. Customized 3D-printed molds for high dose-rate brachytherapy in facial skin cancer: First clinical experience. J Dtsch Dermatol Ges 2023; 21:35-41. [PMID: 36657038 DOI: 10.1111/ddg.14944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 10/05/2022] [Indexed: 01/20/2023]
Abstract
BACKGROUND AND OBJECTIVE Radiotherapy of elderly, frail patients with facial skin cancer in proximity to critical organs is challenging. This is the first report on clinical experience with facial skin cancer treated by individualized 3D-printer-based mold high-dose-rate (HDR) brachytherapy (BT). PATIENTS AND METHODS Fifteen patients not eligible for radical surgery or definitive external beam radiotherapy (EBRT) were treated with 3D-printer-based mold HDR-BT. Patient selection and treatment were in accordance with multidisciplinary tumor board recommendations. Clinical response, toxicity and cosmesis were analyzed. RESULTS Median age was 77 years. Histology revealed squamous cell carcinoma in seven, basal cell carcinoma in five, melanoma in situ in one, Lentigo maligna in one, and melanoma in one patient, respectively. Median prescription dose was 39 Gy delivered in once-daily fractions of 3 Gy. After a median follow-up of 12.2 months, local recurrence was observed in one patient with melanoma in situ. Apart from one grade 4 cataract, no other > grade 2 late toxicity was documented. CONCLUSIONS HDR-BT with 3D-printer-based molds for facial skin cancer is a well-tolerated and safe treatment option for elderly, frail patients not eligible for radical surgery or definitive EBRT due to functional inoperability or tumor location.
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Affiliation(s)
- Georgios Chatzikonstantinou
- Department of Radiotherapy and Oncology, University Hospital, Goethe University Frankfurt am Main, Frankfurt am Main, Germany
| | - Markus Diefenhardt
- Department of Radiotherapy and Oncology, University Hospital, Goethe University Frankfurt am Main, Frankfurt am Main, Germany.,Frankfurt Cancer Institute, Frankfurt am Main, Germany
| | - Maximilian Fleischmann
- Department of Radiotherapy and Oncology, University Hospital, Goethe University Frankfurt am Main, Frankfurt am Main, Germany
| | - Markus Meissner
- Department of Dermatology, Venereology and Allergology, University Hospital, Goethe University Frankfurt am Main, Frankfurt am Main, Germany
| | - Christian Scherf
- Department of Radiotherapy and Oncology, University Hospital, Goethe University Frankfurt am Main, Frankfurt am Main, Germany
| | - Martin Trommel
- Department of Radiotherapy and Oncology, University Hospital, Goethe University Frankfurt am Main, Frankfurt am Main, Germany
| | - Ulla Ramm
- Department of Radiotherapy and Oncology, University Hospital, Goethe University Frankfurt am Main, Frankfurt am Main, Germany
| | - Claus Rödel
- Department of Radiotherapy and Oncology, University Hospital, Goethe University Frankfurt am Main, Frankfurt am Main, Germany.,Frankfurt Cancer Institute, Frankfurt am Main, Germany.,German Cancer Research Center (DKFZ), Heidelberg, German Cancer Consortium (DKTK), Partner Site Frankfurt am Main, Frankfurt am Main, Germany
| | - Nikolaos Tselis
- Department of Radiotherapy and Oncology, University Hospital, Goethe University Frankfurt am Main, Frankfurt am Main, Germany
| | - Jörg Licher
- Department of Radiotherapy and Oncology, University Hospital, Goethe University Frankfurt am Main, Frankfurt am Main, Germany
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13
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Chatzikonstantinou G, Diefenhardt M, Fleischmann M, Meissner M, Scherf C, Trommel M, Ramm U, Rödel C, Tselis N, Licher J. 3D-gedruckte Moulagen für die individualisierte HDR-Brachytherapie kutaner Malignome im Gesichtsbereich: Erste klinische Erfahrungen. J Dtsch Dermatol Ges 2023; 21:35-43. [PMID: 36721945 DOI: 10.1111/ddg.14944_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 10/05/2022] [Indexed: 02/02/2023]
Affiliation(s)
| | - Markus Diefenhardt
- Klinik für Strahlentherapie und Onkologie, Universitätsklinikum, Goethe-Universität, Frankfurt am Main.,Frankfurter Krebsinstitut
| | - Maximilian Fleischmann
- Klinik für Strahlentherapie und Onkologie, Universitätsklinikum, Goethe-Universität, Frankfurt am Main
| | - Markus Meissner
- Klinik für Dermatologie, Venerologie und Allergologie, Universitätsklinikum, Goethe-Universität, Frankfurt am Main
| | - Christian Scherf
- Klinik für Strahlentherapie und Onkologie, Universitätsklinikum, Goethe-Universität, Frankfurt am Main
| | - Martin Trommel
- Klinik für Strahlentherapie und Onkologie, Universitätsklinikum, Goethe-Universität, Frankfurt am Main
| | - Ulla Ramm
- Klinik für Strahlentherapie und Onkologie, Universitätsklinikum, Goethe-Universität, Frankfurt am Main
| | - Claus Rödel
- Klinik für Strahlentherapie und Onkologie, Universitätsklinikum, Goethe-Universität, Frankfurt am Main.,Frankfurter Krebsinstitut.,Deutsches Krebsforschungszentrum (DKFZ), Heidelberg, Deutsches Krebskonsortium (DKTK), Partnerstandort Frankfurt am Main
| | - Nikolaos Tselis
- Klinik für Strahlentherapie und Onkologie, Universitätsklinikum, Goethe-Universität, Frankfurt am Main
| | - Jörg Licher
- Klinik für Strahlentherapie und Onkologie, Universitätsklinikum, Goethe-Universität, Frankfurt am Main
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14
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Bertino G, Groselj A, Campana LG, Kunte C, Schepler H, Gehl J, Muir T, Clover JAP, Quaglino P, Kis E, Mascherini M, Bisase B, Pecorari G, Bechara F, Matteucci P, Odili J, Russano F, Orlando A, Pritchard-Jones R, Moir G, Mowatt D, Silvestri B, Seccia V, Saxinger W, de Terlizzi F, Sersa G. Electrochemotherapy for the treatment of cutaneous squamous cell carcinoma: The INSPECT experience (2008-2020). Front Oncol 2022; 12:951662. [PMID: 36203425 PMCID: PMC9531998 DOI: 10.3389/fonc.2022.951662] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Accepted: 08/26/2022] [Indexed: 12/04/2022] Open
Abstract
Introduction Cutaneous squamous cell carcinoma (cSCC) is a frequent skin cancer with a high risk of recurrence characterized by tumor infiltration and, in advanced cases, a poor prognosis. ECT (electrochemotherapy) is an alternative treatment option for locally advanced or recurrent cSCC that is unsuitable for surgical resection. In this study, we aimed to evaluate the data in the InspECT (International Network for Sharing Practice on ECT) registry of the referral centers and to clarify the indications for the use of ECT as a treatment modality for cSCC. Materials and methods Patients with primary, recurrent or locally advanced cSCC from 18 European centers were included. They underwent at least one ECT session with bleomycin between February 2008 and November 2020, which was performed following the European Standard Operating Procedures. Results The analysis included 162 patients (mean age of 80 years; median, 1 lesion/patient). Side effects were mainly local and mild (hyperpigmentation, 11%; ulceration, 11%; suppuration, 4%). The response to treatment per patient was 62% complete and 21% partial. In the multivariate model, intravenous drug administration and small tumor size showed a significant association with a positive outcome (objective response). One-year local progression-free survival was significantly better (p<0.001) in patients with primary tumors (80% (95% C.I. 70%-90%) than in patients with locally advanced disease (49% (95% C.I. 30%-68%). Conclusion In the present study, ECT showed antitumor activity and a favorable safety profile in patients with complex cSCC for whom there was no widely accepted standard of care. Better results were obtained in primary and small tumors (<3 cm) using intravenous bleomycin administration.
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Affiliation(s)
- Giulia Bertino
- Department of Otolaryngology Head Neck Surgery, University of Pavia, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Matteo Foundation, Pavia, Italy
- *Correspondence: Giulia Bertino,
| | - Ales Groselj
- Department of Otorhinolaryngology and Cervicofacial Surgery, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Luca G. Campana
- Department of Surgery, The Christie National Health Service (NHS) Foundation Trust, Manchester, United Kingdom
| | - Christian Kunte
- Department of Dermatosurgery and Dermatology, Artemed Fachklinik Munich, München, Germany
| | - Hadrian Schepler
- Department of Dermatology, University Medical Center, Johannes Gutenberg University, Mainz, Germany
| | - Julie Gehl
- Center for Experimental Drug and Gene Electrotransfer (CEDGE), Department of Clinical Oncology and Palliative Care, Zealand University Hospital, Roskilde, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Tobian Muir
- Department of Reconstructive Plastic Surgery, James Cook University Hospital, Middlesbrough, United Kingdom
| | - James A. P. Clover
- Department of Plastic Surgery, Cork University Hospital, Cork, Ireland
- Cancer Research @UCC, University College Cork, Cork, Ireland
| | - Pietro Quaglino
- Dermatologic Clinic, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Erika Kis
- Department of Dermatology and Allergology, University of Szeged, Szeged, Hungary
| | - Matteo Mascherini
- Department of Surgical Sciences, Polyclinic Hospital San Martino, Genoa, Italy
| | - Brian Bisase
- Clinic for Head and Neck Cancer, Queen Victoria Hospital National Health Service (NHS) Foundation Trust, East Grinstead, United Kingdom
| | - Giancarlo Pecorari
- Department of Surgical Sciences, Otolaryngology Clinic, University of Turin, Turin, Italy
| | - Falk Bechara
- Department of Dermatologic Surgery, Ruhr-University Bochum, Bochum, Germany
| | - Paolo Matteucci
- Dept Plastic Surgery, Hull University Teaching Hospitals National Health Service (NHS) Trust, Hull, United Kingdom
| | - Joy Odili
- Department of Plastic Surgery, St. Georges University Hospitals National Health Service (NHS) Trust, London, United Kingdom
| | - Francesco Russano
- Melanoma and Sarcoma Surgical Oncology Unit, Veneto Institute of Oncology Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), Padova, Italy
| | - Antonio Orlando
- Southmead Hospital, North Bristol National Health Service (NHS) Trust, Department of Plastic and Reconstructive Surgery, Bristol, United Kingdom
| | - Rowan Pritchard-Jones
- Plastic Reconstructive Surgery, University of Liverpool, St. Helens & Knowsley Teaching Hospitals National Health Service (NHS) Trust, Liverpool, United Kingdom
| | - Graeme Moir
- Department of Cutaneous Medicine and Surgery, The Royal London Hospital & Queen Mary University of London (QMUL), Bart’s Health National Health Service (NHS) Trust, London, United Kingdom
| | - David Mowatt
- Department of Surgery, Christie Hospital, Manchester, United Kingdom
| | - Barbara Silvestri
- Oncology and Haematology Unit, Azienda Unità Sanitaria Locale Socio Sanitaria (AULSS) 3 Serenissima-Mirano, Venice, Italy
| | - Veronica Seccia
- Otorhinolaryngology Audiology and Phoniatric Unit, University Hospital of Pisa, Pisa, Italy
| | - Werner Saxinger
- Department of Dermatology, Klinikum Wels-Grieskirchen, Wels, Austria
| | | | - Gregor Sersa
- Department of Experimental Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
- Faculty of Health Sciences, University of Ljubljana, Ljubljana, Slovenia
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15
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Sun X, Chen W, Qu X, Chen Y. Case Report: Fluzoparib for multiple lines of chemotherapy refractory in metastatic cutaneous squamous cell carcinoma with BRCA2 pathogenic mutation. Front Pharmacol 2022; 13:968060. [PMID: 36034850 PMCID: PMC9411933 DOI: 10.3389/fphar.2022.968060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 07/15/2022] [Indexed: 11/13/2022] Open
Abstract
Background: Poly ADP-ribose polymerase inhibitors (PARPis) are widely used for patients with BRCA1/2 mutations. However, until now, there is no available evidence reported for the efficiency of PARPis in cutaneous squamous cell carcinoma (cSCC). Case presentation: We presented a case of a 40-year-old man diagnosed with metastatic cSCC, relapsing after multiple lines of chemotherapy. Liquid biopsy detected a BRCA2 pathogenic germline mutation (c.3109C > T), indicating PARPis might be effective for this patient. The patient achieved tumor stability, and progression-free survival was five months without severe adverse effects after taking fluzoparib. Conclusion: This result confirmed that PARPis were effective for metastatic cSCC patients with germline BRCA2 pathogenic mutations and provided a new treatment option for this group of patients.
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Affiliation(s)
- Xin Sun
- Department of Medical Oncology, The First Hospital of China Medical University, Shenyang, China
| | - Wenjuan Chen
- Department of Medical Oncology, The First Hospital of China Medical University, Shenyang, China
| | - Xiujuan Qu
- Department of Medical Oncology, The First Hospital of China Medical University, Shenyang, China
- Key Laboratory of Anticancer Drugs and Biotherapy of Liaoning Province, The First Hospital of China Medical University, Shenyang, China
- Liaoning Province Clinical Research Center for Cancer, Shenyang, China
- Key Laboratory of Precision Diagnosis and Treatment of Gastrointestinal Tumors, Ministry of Education, The First Hospital of China Medical University, Shenyang, China
- *Correspondence: Ying Chen, , orcid.org/0000-0002-0022-4034, Xiujuan Qu, , orcid.org/0000-0002-3135-8772
| | - Ying Chen
- Department of Medical Oncology, The First Hospital of China Medical University, Shenyang, China
- Key Laboratory of Anticancer Drugs and Biotherapy of Liaoning Province, The First Hospital of China Medical University, Shenyang, China
- Liaoning Province Clinical Research Center for Cancer, Shenyang, China
- Key Laboratory of Precision Diagnosis and Treatment of Gastrointestinal Tumors, Ministry of Education, The First Hospital of China Medical University, Shenyang, China
- *Correspondence: Ying Chen, , orcid.org/0000-0002-0022-4034, Xiujuan Qu, , orcid.org/0000-0002-3135-8772
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16
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Baba N, Kato H, Nakamura M, Matsushita S, Aoki M, Fujimoto N, Kato T, Iino S, Saito S, Yasuda M, Asai J, Ishikawa M, Yatsushiro H, Kawahara Y, Matsuya T, Araki R, Teramoto Y, Hasegawa M, Tokunaga T, Nakamura Y. Narrower clinical margin in high or very high-risk squamous cell carcinoma: a retrospective, multicenter study of 1,000 patients. J Dtsch Dermatol Ges 2022; 20:1088-1099. [PMID: 35927033 DOI: 10.1111/ddg.14810] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 04/04/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND OBJECTIVES In cutaneous squamous cell carcinoma (cSCC), adherence to guideline-recommended fixed surgical margins is often difficult, and narrower margins are preferable. This study aimed to evaluate relapse and disease-specific death with narrower margins for high or very high-risk cSCC. PATIENTS/METHODS We retrospectively investigated high or very high-risk cSCC patients who underwent tumor excision. Patients were divided into guideline-recommended standard margin group (SMG) and narrower-margin group (NMG). Co-primary outcomes were local relapse, SCC relapse, and SCC death. Cumulative incidence function (CIF) was used to describe SCC death probability and competing risk mortality. Gray's test was used to compare differences in CIF between the groups. RESULTS In total, 1,000 patients with cSCC (high-risk, 570; very high-risk, 430) were included. In the high-risk cohort, there were no significant differences in incomplete excision rate (IER) between SMG and NMG (2.6 % vs. 3.0 %, P > 0.99). However, in the very high-risk cohort, IER in SMG was significantly lower than in NMG (8.9 % vs. 16.2 %, P = 0.03). No significant differences were observed between SMG and NMG for local relapse (high-risk, P = 0.56; very high-risk, P = 0.70), SCC relapse (high-risk, P = 0.30; very high-risk, P = 0.47), and SCC death (high-risk, P = 0.23; very high-risk, P = 0.83). CONCLUSIONS Surgical margin size has limited impact on margin control, relapse, and disease-specific death in high-risk cSCC.
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Affiliation(s)
- Natsuki Baba
- Department of Skin Oncology/Dermatology, Saitama Medical University International Medical Center, Saitama, Japan.,Department of Dermatology, University of Fukui, Fukui, Japan
| | - Hiroshi Kato
- Department of Geriatric and Environmental Dermatology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Motoki Nakamura
- Department of Geriatric and Environmental Dermatology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Shigeto Matsushita
- Department of Dermato-Oncology/Dermatology, National Hospital Organization Kagoshima Medical Center, Kagoshima, Japan
| | - Megumi Aoki
- Department of Dermato-Oncology/Dermatology, National Hospital Organization Kagoshima Medical Center, Kagoshima, Japan
| | - Noriki Fujimoto
- Department of Dermatology, Shiga University of Medical Science, Otsu, Japan
| | - Takeshi Kato
- Department of Dermatology, Shiga University of Medical Science, Otsu, Japan
| | - Shiro Iino
- Department of Dermatology, University of Fukui, Fukui, Japan
| | - Shintaro Saito
- Department of Dermatology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Masahito Yasuda
- Department of Dermatology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Jun Asai
- Department of Dermatology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Masashi Ishikawa
- Department of Dermatology, Saitama Cancer Center, Saitama, Japan
| | | | - Yu Kawahara
- Department of Dermatology, Kimitsu Chuo Hospital, Kisarazu, Japan
| | - Taisuke Matsuya
- Department of Dermatology, Asahikawa Medical University, Hokkaido, Japan
| | - Ryuichiro Araki
- Community Health Science Center, Saitama Medical University, Saitama, Japan
| | - Yukiko Teramoto
- Department of Skin Oncology/Dermatology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Minoru Hasegawa
- Department of Dermatology, University of Fukui, Fukui, Japan
| | - Takahiro Tokunaga
- Medical Research Support Center, University of Fukui Hospital, Fukui, Japan.,Research Promotion Office, Shinseikai Toyama Hospital, Toyama, Japan
| | - Yasuhiro Nakamura
- Department of Skin Oncology/Dermatology, Saitama Medical University International Medical Center, Saitama, Japan
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17
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Baba N, Kato H, Nakamura M, Matsushita S, Aoki M, Fujimoto N, Kato T, Iino S, Saito S, Yasuda M, Asai J, Ishikawa M, Yatsushiro H, Kawahara Y, Matsuya T, Araki R, Teramoto Y, Hasegawa M, Tokunaga T, Nakamura Y. Knapperer Resektionsrand bei Plattenepithelkarzinomen mit hohem oder sehr hohem Risiko: eine retrospektive multizentrische Studie mit 1000 Patienten. J Dtsch Dermatol Ges 2022; 20:1088-1100. [PMID: 35971579 DOI: 10.1111/ddg.14810_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 04/04/2022] [Indexed: 11/27/2022]
Abstract
HINTERGRUND UND ZIELE Bei kutanen Plattenepithelkarzinomen (PEK) ist die Einhaltung der in Leitlinien empfohlenen festen Resektionsränder oft schwierig und knappere Ränder sind wünschenswert. Ziel dieser Studie war die Bewertung des Auftretens von Rezidiven und krankheitsspezifischen Todesfällen bei knapperen Resektionsrändern für PEK mit hohem oder sehr hohem Risiko. PATIENTEN/METHODEN PEK-Patienten mit hohem oder sehr hohem Risiko, bei denen eine Tumorexzision durchgeführt wurde, wurden retrospektiv untersucht. Die Patienten wurden in eine Gruppe mit Standardrand gemäß Leitlinienempfehlung (standard margin group, SMG) und eine Gruppe mit knapperen Rändern (narrower-margin group, NMG) eingeteilt. Gemeinsame primäre Endpunkte waren lokales Rezidiv, PEK-Rezidiv und PEK-bedingter Tod. Die Wahrscheinlichkeit eines PEK-bedingten Tods und konkurrierender Mortalitätsrisiken wurde mittels kumulativer Inzidenzfunktion (CIF) beschrieben. Unterschiede bei der CIF zwischen den Gruppen wurden mit dem Test nach Gray verglichen. ERGEBNISSE Insgesamt wurden 1.000 Patienten mit PEK (hohes Risiko, 570; sehr hohes Risiko, 430) eingeschlossen. In der Kohorte mit hohem Risiko gab es keine signifikanten Unterschiede bei der unvollständigen Exzisionsrate (IER) zwischen SMG und NMG (2,6 % vs. 3,0 %, P > 0,99). In der Kohorte mit sehr hohem Risiko war die IER in der SMG jedoch signifikant geringer als in der NMG (8.9 % vs. 16.2 %, P = 0,03). Keine signifikanten Unterschiede zwischen SMG und NMG wurden für Lokalrezidiv (hohes Risiko, P = 0.56; sehr hohes Risiko, P = 0,70), PEK-Rezidiv (hohes Risiko, P = 0,30; sehr hohes Risiko, P = 0,47) und PEK-bedingtem Tod (hohes Risiko, P = 0,23; sehr hohes Risiko, P = 0,83) beobachtet. SCHLUSSFOLGERUNGEN Die Größe des Resektionsrands hat einen begrenzten Einfluss auf Randkontrolle, Rezidive und krankheitsspezifischen Tod bei PEK mit hohem Risiko.
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Affiliation(s)
- Natsuki Baba
- Department of Skin Oncology/Dermatology, Saitama Medical University International Medical Center, Saitama, Japan.,Department of Dermatology, University of Fukui, Fukui, Japan
| | - Hiroshi Kato
- Department of Geriatric and Environmental Dermatology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Motoki Nakamura
- Department of Geriatric and Environmental Dermatology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Shigeto Matsushita
- Department of Dermato-Oncology/Dermatology, National Hospital Organization Kagoshima Medical Center, Kagoshima, Japan
| | - Megumi Aoki
- Department of Dermato-Oncology/Dermatology, National Hospital Organization Kagoshima Medical Center, Kagoshima, Japan
| | - Noriki Fujimoto
- Department of Dermatology, Shiga University of Medical Science, Otsu, Japan
| | - Takeshi Kato
- Department of Dermatology, Shiga University of Medical Science, Otsu, Japan
| | - Shiro Iino
- Department of Dermatology, University of Fukui, Fukui, Japan
| | - Shintaro Saito
- Department of Dermatology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Masahito Yasuda
- Department of Dermatology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Jun Asai
- Department of Dermatology, Kyoto Prefectural University of Medicine, Kyoto, Japan
| | - Masashi Ishikawa
- Department of Dermatology, Saitama Cancer Center, Saitama, Japan
| | | | - Yu Kawahara
- Department of Dermatology, Kimitsu Chuo Hospital, Kisarazu, Japan
| | - Taisuke Matsuya
- Department of Dermatology, Asahikawa Medical University, Hokkaido, Japan
| | - Ryuichiro Araki
- Community Health Science Center, Saitama Medical University, Saitama, Japan
| | - Yukiko Teramoto
- Department of Skin Oncology/Dermatology, Saitama Medical University International Medical Center, Saitama, Japan
| | - Minoru Hasegawa
- Department of Dermatology, University of Fukui, Fukui, Japan
| | - Takahiro Tokunaga
- Medical Research Support Center, University of Fukui Hospital, Fukui, Japan.,Research Promotion Office, Shinseikai Toyama Hospital, Toyama, Japan
| | - Yasuhiro Nakamura
- Department of Skin Oncology/Dermatology, Saitama Medical University International Medical Center, Saitama, Japan
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18
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Hansen I, Augustin M, Schäfer I, Mohr N. Epidemiologie von Hautkrankheiten in Deutschland: systematische Literaturanalyse des aktuellen Forschungsstands - Teil 1: Tumorerkrankungen der Haut. J Dtsch Dermatol Ges 2022; 20:257-271. [PMID: 35304947 DOI: 10.1111/ddg.14746_g] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 11/19/2021] [Indexed: 01/14/2023]
Affiliation(s)
- Inga Hansen
- Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen (IVDP), Universitätsklinikum Hamburg-Eppendorf (UKE), Hamburg
| | - Matthias Augustin
- Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen (IVDP), Universitätsklinikum Hamburg-Eppendorf (UKE), Hamburg
| | - Ines Schäfer
- Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen (IVDP), Universitätsklinikum Hamburg-Eppendorf (UKE), Hamburg
| | - Nicole Mohr
- Institut für Versorgungsforschung in der Dermatologie und bei Pflegeberufen (IVDP), Universitätsklinikum Hamburg-Eppendorf (UKE), Hamburg
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19
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Hansen I, Augustin M, Schäfer I, Mohr N. Epidemiology of skin diseases in Germany: systematic review of the current state of research - part 1: cutaneous tumor diseases. J Dtsch Dermatol Ges 2022; 20:257-270. [PMID: 35246923 DOI: 10.1111/ddg.14746] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 11/19/2021] [Indexed: 12/16/2022]
Abstract
Epidemiological data are of great importance for the identification of health care needs, the detection of gaps in care, the development of targeted prevention measures, and for the optimization of resource allocation. The aim of this work was to systematically collect all previously published population-based epidemiological data on skin diseases in Germany. The present part 1 of the publication series deals with tumor diseases of the skin. The results on non-infectious (part 2) and infectious skin diseases (part 3) form the other parts of this publication series. A systematic search of the literature spanning the last 15 years was conducted using the PubMed/MEDLINE database. With the aim of including all dermatologic diseases, a diagnostic list was developed based on the ICD-11 catalogue. This list included 1,347 skin diseases and formed the basis for the search. The literature search yielded 4,650 publications. After two-stage screening, 72 studies on 43 different skin diseases were included in the synthesis. Among them were 30 publications on cutaneous tumor diseases, the majority was related to malignant melanoma. This work is the first systematic literature review that aimed to report all available epidemiological data on skin diseases in Germany. In terms of study characteristics, a high heterogeneity was found for the different skin diseases. Even though the methodology of the included epidemiological studies varied considerably, the usefulness of these epidemiological data is extremely wide-ranging. Thus, this work can serve as a reference for various epidemiological questions.
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Affiliation(s)
- Inga Hansen
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Matthias Augustin
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Ines Schäfer
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
| | - Nicole Mohr
- Institute for Health Services Research in Dermatology and Nursing (IVDP), University Medical Center Hamburg-Eppendorf (UKE), Hamburg, Germany
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20
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Topical Pharmacotherapy for Actinic Keratoses in Older Adults. Drugs Aging 2022; 39:143-152. [PMID: 35156172 PMCID: PMC8873057 DOI: 10.1007/s40266-022-00919-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/10/2022] [Indexed: 11/21/2022]
Abstract
Actinic keratosis is caused by excessive lifetime sun exposure. It must be treated, regardless of thickness, because it is the biologic precursor of invasive squamous cell carcinoma, a potentially deadly malignancy. Physical ablative techniques such as cryotherapy, lasers, and curettage are the most used treatments for isolated lesions. Multiple lesions are treated with topical drugs, chemical peelings, and physical techniques. Drug preparations containing diclofenac plus hyaluronate, aminolevulinic acid, and methyl aminolevulinate and different concentrations of imiquimod and 5-fluorouracil are approved for this clinical indication. All treatments have a good profile of efficacy and tolerability although there are relevant differences in the clearance rate, tolerability, and type and frequency of adverse effects. In addition, they have very different mechanisms of action and treatment protocols. No differences in the efficacy and tolerability were found in older patients compared with younger patients, therefore no dose adjustments are needed. That said, older patients often need to be motivated to treat actinic keratoses and a careful attention to expectations, needs, and preferences should be used to obtain the maximal adherence and prevent treatment failure. This goal can be achieved with a careful evaluation not only of published efficacy, toxicity, and tolerability data but also of practical topics such as the frequency of daily applications, the overall duration of therapy, and the need for a caregiver. Finally, particular attention must be paid in the case of frail patients and immunosuppressed patients.
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21
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Hoffmann JC, Schön MP. Integrin α E(CD103)β 7 in Epithelial Cancer. Cancers (Basel) 2021; 13:6211. [PMID: 34944831 PMCID: PMC8699740 DOI: 10.3390/cancers13246211] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 11/29/2021] [Accepted: 12/08/2021] [Indexed: 01/22/2023] Open
Abstract
Interactions of both the innate and the adaptive immune system with tumors are complex and often influence courses and therapeutic treatments in unanticipated ways. Based on the concept that CD8+T cells can mediate important antitumor effects, several therapies now aim to amplify their specific activity. A subpopulation of CD8+ tissue-resident T lymphocytes that express the αE(CD103)β7 integrin has raised particular interest. This receptor presumably contributes to the recruitment and retention of tumor-infiltrating immune cells through interaction with its ligand, E-cadherin. It appears to have regulatory functions and is thought to be a component of some immunological synapses. In TGF-rich environments, the αE(CD103)β7/E-cadherin-interaction enhances the binding strength between tumor cells and infiltrating T lymphocytes. This activity facilitates the release of lytic granule contents and cytokines as well as further immune responses and the killing of target cells. Expression of αE(CD103)β7 in some tumors is associated with a rather favorable prognosis, perhaps with the notable exception of squamous cell carcinoma of the skin. Although epithelial skin tumors are by far the most common tumors of fair-skinned people, there have been very few studies on the distribution of αE(CD103)β7 expressing cells in these neoplasms. Given this background, we describe here that αE(CD103)β7 is scarcely present in basal cell carcinomas, but much more abundant in squamous cell carcinomas with heterogeneous distribution. Notwithstanding a substantial number of studies, the role of αE(CD103)β7 in the tumor context is still far from clear. Here, we summarize the essential current knowledge on αE(CD103)β7 and outline that it is worthwhile to further explore this intriguing receptor with regard to the pathophysiology, therapy, and prognosis of solid tumors.
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Affiliation(s)
- Johanna C. Hoffmann
- Department of Dermatology, Venereology and Allergology, University Medical Center Göttingen, 37075 Göttingen, Germany;
| | - Michael P. Schön
- Department of Dermatology, Venereology and Allergology, University Medical Center Göttingen, 37075 Göttingen, Germany;
- Lower Saxony Institute of Occupational Dermatology, University Medical Center Göttingen, 37075 Göttingen, Germany
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22
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Dessinioti C, Stratigos AJ. Overview of guideline recommendations for the management of high-risk and advanced cutaneous squamous cell carcinoma. J Eur Acad Dermatol Venereol 2021; 36 Suppl 1:11-18. [PMID: 34855249 DOI: 10.1111/jdv.17531] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Accepted: 07/02/2021] [Indexed: 11/29/2022]
Abstract
Cutaneous squamous cell carcinoma (cSCC) is the second most common form of skin cancer. National and international associations have issued evidence- and consensus-based guidelines to offer clinicians a framework to optimally manage patients with invasive cSCC. Current updated guidelines regarding the recommendations on the management of patients with high-risk and advanced cSCC include EDF/EADO (European) Guidelines 2020, US National Comprehensive Cancer Network guidelines 2021, American Academy of Dermatology guidelines 2018, British Association of Dermatology guidelines 2020 and German guidelines 2020. This review presents the guideline recommendations on the definition of high-risk and advanced cSCC, surgical treatment and safety margins, definitive and adjuvant radiotherapy and systemic treatments. The recommendations across guidelines may converge, diverge or in some cases not be able to provide a recommendation, highlighting open questions to be answered by future studies.
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Affiliation(s)
- C Dessinioti
- 1st Department of Dermatology-Venereology, National and Kapodistrian University of Athens, Andreas Sygros Hospital, Athens, Greece
| | - A J Stratigos
- 1st Department of Dermatology-Venereology, National and Kapodistrian University of Athens, Andreas Sygros Hospital, Athens, Greece
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23
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Nägeli M, Mangana J, Chaloupka K, Dummer R. Cutaneous SCC with orbital invasion: case series. J Eur Acad Dermatol Venereol 2021; 36 Suppl 1:59-62. [PMID: 34855245 DOI: 10.1111/jdv.17529] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 06/29/2021] [Accepted: 07/07/2021] [Indexed: 11/26/2022]
Abstract
Cutaneous squamous cell carcinoma (cSCC) is the most common tumour entity that grows secondarily into the orbital area, while basal cell carcinoma (BCC) is the most common periocular and eyelid tumour. Diagnostic delays are common and may increase post-treatment complications. The therapy is challenging and must be discussed at an interdisciplinary tumour board. We discuss four cases of cSCC with orbital invasion treated with immune-checkpoint inhibitors with variable responses.
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Affiliation(s)
- M Nägeli
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | - J Mangana
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
| | - K Chaloupka
- Department of Ophthalmology, University Hospital Zurich, Zurich, Switzerland
| | - R Dummer
- Department of Dermatology, University Hospital Zurich, Zurich, Switzerland
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24
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Morandi EM, Rauchenwald T, Puelzl P, Zelger BW, Zelger BG, Henninger B, Pierer G, Wolfram D. Hide-and-seek: Neurotropic squamous cell carcinoma of the periorbital region - a series of five cases and review of the literature. J Dtsch Dermatol Ges 2021; 19:1571-1580. [PMID: 34811913 PMCID: PMC9299592 DOI: 10.1111/ddg.14582] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 06/07/2021] [Indexed: 12/11/2022]
Abstract
Squamous cell carcinoma is the second most common malignancy of the skin after basal cell carcinoma and mainly found in sun‐exposed areas such as the face. This mostly locally destructive malignancy may show invasive growth and insidious mechanisms of dissemination such as perineural invasion. Periorbital squamous cell carcinoma is associated with perineural invasion in up to 14 % of cases. Specifically in this region, the proximity to cranial nerves and therefore the associated risk of progression to the central nervous system are associated with poor prognosis. The clinically concealed character of this entity often leads to a delay in diagnosis and consequently makes complete resection and reconstruction demanding. Careful clinical evaluation often hints at perineural invasion before obtaining histology. Aside from presenting five challenging cases, this work analyzes risk factors, clinical as well as histological features, and treatment options for periorbital squamous cell carcinoma with perineural invasion.
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Affiliation(s)
- Evi M Morandi
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Tina Rauchenwald
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Petra Puelzl
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Bernhard W Zelger
- Department of Dermatology, Venerology and Allergology, Medical University of Innsbruck, Innsbruck, Austria
| | - Bettina G Zelger
- Department of Pathology, Medical University of Innsbruck, Innsbruck, Austria
| | - Benjamin Henninger
- Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
| | - Gerhard Pierer
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Innsbruck, Innsbruck, Austria
| | - Dolores Wolfram
- Department of Plastic, Reconstructive and Aesthetic Surgery, Medical University of Innsbruck, Innsbruck, Austria
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25
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Morandi EM, Rauchenwald T, Puelzl P, Zelger BW, Zelger BG, Henninger B, Pierer G, Wolfram D. Hide-and-seek: Neurotropes Plattenepithelkarzinom der periorbitalen Region - eine Fallserie und Übersichtsarbeit aktueller Literatur. J Dtsch Dermatol Ges 2021; 19:1571-1581. [PMID: 34811899 DOI: 10.1111/ddg.14582_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 06/07/2021] [Indexed: 11/30/2022]
Abstract
Das Plattenepithelkarzinom ist nach dem Basalzellkarzinom das zweithäufigste Malignom der Haut und wird vorwiegend an sonnenexponierten Stellen wie der Gesichtshaut diagnostiziert. Diese meist lokal destruktiv wachsende Malignität kann durchaus auch invasives Wachstumsverhalten, wie perineurale Ausbreitungsmechanismen, aufweisen. Das Plattenepithelkarzinom der periorbitalen Region ist in bis zu 14 % der Fälle mit perineuraler Invasion assoziiert. Vor allem in diesem Bereich birgt die anatomische Nähe zu den Hirnnerven das Risiko einer Progression Richtung zentrales Nervensystem, was mit einer schlechteren Prognose assoziiert ist. Der klinisch unauffällige Charakter dieser Entität resultiert oft in einer Verzögerung der definitiven Diagnosestellung, wodurch die vollständige Resektion und anschließende Rekonstruktion erschwert werden. Eine aufmerksame klinische Evaluierung kann bereits vor Erlangen histologischer Befunde Hinweise für ein perineurales Wachstum liefern. Neben fünf herausfordernden Fällen analysiert diese Arbeit Risikofaktoren, klinische als auch histologische Merkmale und Behandlungsoptionen des periorbitalen Plattenepithelkarzinoms mit perineuraler Invasion.
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Affiliation(s)
- Evi M Morandi
- Universitätsklinik für Plastische, Rekonstruktive und Ästhetische Chirurgie, Medizinische Universität Innsbruck, Innsbruck, Österreich
| | - Tina Rauchenwald
- Universitätsklinik für Plastische, Rekonstruktive und Ästhetische Chirurgie, Medizinische Universität Innsbruck, Innsbruck, Österreich
| | - Petra Puelzl
- Universitätsklinik für Plastische, Rekonstruktive und Ästhetische Chirurgie, Medizinische Universität Innsbruck, Innsbruck, Österreich
| | - Bernhard W Zelger
- Universitätsklinik für Dermatologie und Venerologie, Medizinische Universität Innsbruck, Innsbruck, Österreich
| | - Bettina G Zelger
- Institut für Pathologie, Medizinische Universität Innsbruck, Innsbruck, Österreich
| | - Benjamin Henninger
- Universitätsklinik für Radiologie, Medizinische Universität Innsbruck, Innsbruck, Österreich
| | - Gerhard Pierer
- Universitätsklinik für Plastische, Rekonstruktive und Ästhetische Chirurgie, Medizinische Universität Innsbruck, Innsbruck, Österreich
| | - Dolores Wolfram
- Universitätsklinik für Plastische, Rekonstruktive und Ästhetische Chirurgie, Medizinische Universität Innsbruck, Innsbruck, Österreich
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26
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Garbe C, Schadendorf D, Tilgen W, Gutzmer R, Berking C, Mohr P, Kaufmann R, Breitbart E, Weber C, Volkenandt M, Hauschild A. 30 years German Dermatologic Cooperative Oncology Group (DeCOG). J Dtsch Dermatol Ges 2021; 19:1682-1697. [PMID: 34677891 DOI: 10.1111/ddg.14628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 08/05/2021] [Indexed: 11/29/2022]
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27
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Garbe C, Schadendorf D, Tilgen W, Gutzmer R, Berking C, Mohr P, Kaufmann R, Breitbart E, Weber C, Volkenandt M, Hauschild A. 30 Jahre Arbeitsgemeinschaft Dermatologische Onkologie (ADO). J Dtsch Dermatol Ges 2021; 19:1682-1697. [PMID: 34677896 DOI: 10.1111/ddg.14628_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Accepted: 08/05/2021] [Indexed: 11/30/2022]
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28
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Kromer C, Vlahova LD, Julius K, Schnabel V, Schön MP, Gottberg PV, Kretschmer L. Subgaleale Infiltration verbessert MRT‐gestützte Operationsplanung bei Kopfhauttumoren. J Dtsch Dermatol Ges 2021; 19:1524-1526. [PMID: 34661360 DOI: 10.1111/ddg.14531_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Christian Kromer
- Department of Dermatology, Venereology, and Allergology, University Medical Center, Göttingen, Göttingen, Germany
| | - Lyubomira D Vlahova
- Department of Dermatology, Venereology, and Allergology, University Medical Center, Göttingen, Göttingen, Germany
| | - Katharina Julius
- Department of Dermatology, Venereology, and Allergology, University Medical Center, Göttingen, Göttingen, Germany
| | - Viktor Schnabel
- Department of Dermatology, Venereology, and Allergology, University Medical Center, Göttingen, Göttingen, Germany
| | - Michael P Schön
- Department of Dermatology, Venereology, and Allergology, University Medical Center, Göttingen, Göttingen, Germany.,Lower Saxony Institute of Occupational Dermatology, University Medical Center Göttingen, Göttingen, Germany
| | - Philipp V Gottberg
- Institute of diagnostic and interventional Neuroradiology, University Medical Center, Göttingen, Göttingen, Germany
| | - Lutz Kretschmer
- Department of Dermatology, Venereology, and Allergology, University Medical Center, Göttingen, Göttingen, Germany
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29
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Ruini C, Schuh S, Gust C, Kendziora B, Frommherz L, French LE, Hartmann D, Welzel J, Sattler EC. Line-field confocal optical coherence tomography for the in vivo real-time diagnosis of different stages of keratinocyte skin cancer: a preliminary study. J Eur Acad Dermatol Venereol 2021; 35:2388-2397. [PMID: 34415646 DOI: 10.1111/jdv.17603] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 08/03/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND The treatment of keratinocyte cancers (KC) strictly depends on their differentiation and invasiveness. Non-invasive diagnostic techniques can support the diagnosis in real time, avoiding unnecessary biopsies. This study aimed to preliminarily define main imaging criteria and histological correlations of actinic keratosis (AK), Bowen's disease (BD) and squamous cell carcinoma (SCC) using the novel device line-field confocal optical coherence tomography (LC-OCT). METHODS Dermoscopy and LC-OCT images of 73 histopathologically confirmed lesions (46 AKs, 11 BD and 16 SCCs) were included in the study. Exemplary lesions (10 AKs, 5 BD and 5 SCCs) were additionally investigated with optical coherence tomography and reflectance confocal microscopy. RESULTS Most common LC-OCT findings of KC in the descriptive statistics were hyperkeratosis/parakeratosis, disruption of stratum corneum, broadened epidermis, basal and suprabasal keratinocyte atypia, dilated vessels/neoangiogenesis and elastosis/collagen alterations. In the univariate multinomial logistic regression, a preserved DEJ was less common in SCC compared with AK and BD, BD displayed marked keratinocyte atypia involving all epidermal layers (bowenoid pattern), while SCC showed ulceration, increased epidermal thickness, keratin plugs, acantholysis, not visible/interrupted DEJ and epidermal bright particles. LC-OCT increased the diagnostic confidence by 24.7% compared with dermoscopy alone. CONCLUSIONS Our study describes for the first time specific LC-OCT features of different stages of KC and their histopathological correlates, focusing on keratinocyte morphology and architecture of the epidermis and DEJ. LC-OCT may open new scenarios in the bedside diagnosis, treatment planning and follow-up of KC.
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Affiliation(s)
- C Ruini
- Department of Dermatology and Allergy, University Hospital, LMU Munich, Germany.,PhD School in Clinical and Experimental Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - S Schuh
- Department of Dermatology and Allergy, University Hospital, Augsburg, Germany
| | - C Gust
- Department of Dermatology and Allergy, University Hospital, LMU Munich, Germany
| | - B Kendziora
- Department of Dermatology and Allergy, University Hospital, LMU Munich, Germany
| | - L Frommherz
- Department of Dermatology and Allergy, University Hospital, LMU Munich, Germany
| | - L E French
- Department of Dermatology and Allergy, University Hospital, LMU Munich, Germany.,Dr. Phillip Frost Department of Dermatology & Cutaneous Surgery, Miller School of Medicine, University of Miami, Coral Gables, FL, USA
| | - D Hartmann
- Department of Dermatology and Allergy, University Hospital, LMU Munich, Germany
| | - J Welzel
- Department of Dermatology and Allergy, University Hospital, Augsburg, Germany
| | - E C Sattler
- Department of Dermatology and Allergy, University Hospital, LMU Munich, Germany
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30
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Kromer C, Vlahova LD, Julius K, Schnabel V, Schön MP, Gottberg PV, Kretschmer L. Subgaleal infiltration improves MRI-supported surgical planning for scalp tumors. J Dtsch Dermatol Ges 2021; 19:1524-1526. [PMID: 34191383 DOI: 10.1111/ddg.14531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 03/29/2021] [Indexed: 12/01/2022]
Affiliation(s)
- Christian Kromer
- Department of Dermatology, Venereology, and Allergology, University Medical Center, Göttingen, Göttingen, Germany
| | - Lyubomira D Vlahova
- Department of Dermatology, Venereology, and Allergology, University Medical Center, Göttingen, Göttingen, Germany
| | - Katharina Julius
- Department of Dermatology, Venereology, and Allergology, University Medical Center, Göttingen, Göttingen, Germany
| | - Viktor Schnabel
- Department of Dermatology, Venereology, and Allergology, University Medical Center, Göttingen, Göttingen, Germany
| | - Michael P Schön
- Department of Dermatology, Venereology, and Allergology, University Medical Center, Göttingen, Göttingen, Germany.,Lower Saxony Institute of Occupational Dermatology, University Medical Center Göttingen, Göttingen, Germany
| | - Philipp V Gottberg
- Institute of diagnostic and interventional Neuroradiology, University Medical Center, Göttingen, Göttingen, Germany
| | - Lutz Kretschmer
- Department of Dermatology, Venereology, and Allergology, University Medical Center, Göttingen, Göttingen, Germany
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31
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Warnig C, Wollina U. Cutaneous squamous cell carcinoma of head and neck region: A single center analysis of 1296 tumors with clinical characteristics, comorbidities, treatment, and sun-protection behavior. Dermatol Ther 2021; 34:e14992. [PMID: 34009659 DOI: 10.1111/dth.14992] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2021] [Accepted: 05/12/2021] [Indexed: 01/02/2023]
Abstract
Cutaneous squamous cell carcinoma (SCC) is the second most common non-melanoma skin cancer among Caucasians. We analyzed our data on tumors been treated between 2006 and 2016 at the Skin Cancer Center of an academic teaching hospital. Thousand hundred and ninety-four patients with 1296 SCC have been identified including 804 males (67.3%) and 390 females (32.7%). The mean age among females was significantly higher with (83.9 ± 7.9) years compared with males ([79.3 ± 8.1] years; P < .001). The most common tumor localizations were outer ears (n = 227, 17.5%), scalp (216, 16.7%), and forehead (215, 16.6%). The majority of tumors was stage I. 31.9% of patients had previous SCC or Bowen's cancer, 29.1% had actinic keratoses. Major non-dermatological comorbidities were cardiovascular diseases and diabetes. SCC were treated by delayed Mohs surgery. First Mohs procedure resulted in R0 status in 83.9%. Most cases with R1 resection were located on nose and eyelids. For a subpopulation of patients (n = 105), a structured questionnaire study evaluated changes in sun protection behavior after skin cancer. After the confirmed diagnosis of a cutaneous SCC concerns about harm to the skin by intense sunlight was reported by 78.4% (76) of participants, with 92.0% among females versus 73.6% among males. Eighty percent of females and 76.8% of males wanted to care more about sun-protection in the future, spend less time 84.0% (females) and 72.5% (males) in the sun, and adapt their leisure activities for a better sun protection in 92.0% (females) and 81.9% (males). Secondary prevention in males needs improvement.
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Affiliation(s)
- Caroline Warnig
- Department of Dermatology and Allergology, Städtisches Klinikum Dresden, Academic Teaching Hospital, Dresden, Germany
| | - Uwe Wollina
- Department of Dermatology and Allergology, Städtisches Klinikum Dresden, Academic Teaching Hospital, Dresden, Germany
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Wessely A, Steeb T, Heppt F, Hornung A, Kaufmann MD, Koch EAT, Toussaint F, Erdmann M, Berking C, Heppt MV. A Critical Appraisal of Evidence- and Consensus-Based Guidelines for Actinic Keratosis. ACTA ACUST UNITED AC 2021; 28:950-960. [PMID: 33617511 PMCID: PMC7985770 DOI: 10.3390/curroncol28010093] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 02/10/2021] [Accepted: 02/14/2021] [Indexed: 11/16/2022]
Abstract
Actinic keratoses (AK) are common lesions of the skin that can be effectively treated with several lesion- and field-directed treatments. Clinical practice guidelines assist physicians in choosing the appropriate treatment options for their patients. Here, we aimed to systematically identify and evaluate the methodological quality of currently available guidelines for AK. Guidelines published within the last 5 years were identified in a systematic search of guideline databases, Medline and Embase. Then, six independent reviewers evaluated the methodological quality using the tools "Appraisal of Guidelines for Research and Evaluation" (AGREE II) and "Recommendation EXcellence" (AGREE-REX). The Kruskal-Wallis (H) test was used to explore differences among subgroups and Spearman's correlation to examine the relationship between individual domains. Three guidelines developed by consortia from Canada, Germany and the United Kingdom were eligible for the evaluation. The German guideline achieved the highest scores, fulfilling 65 to 92% of the criteria in AGREE II and 67 to 84% in AGREE-REX, whereas the Canadian guideline scored 31 to 71% of the criteria in AGREE II and 33 to 46% in AGREE-REX. The domains "stakeholder involvement" and "values and preferences" were identified as methodological weaknesses requiring particular attention and improvement in future guideline efforts.
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Affiliation(s)
- Anja Wessely
- Department of Dermatology, Deutsches Zentrum Immuntherapie (DZI), Universitätsklinikum Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (A.W.); (T.S.); (F.H.); (A.H.); (M.D.K.); (E.A.T.K.); (F.T.); (M.E.); (C.B.)
- Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN), 91054 Erlangen, Germany
| | - Theresa Steeb
- Department of Dermatology, Deutsches Zentrum Immuntherapie (DZI), Universitätsklinikum Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (A.W.); (T.S.); (F.H.); (A.H.); (M.D.K.); (E.A.T.K.); (F.T.); (M.E.); (C.B.)
- Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN), 91054 Erlangen, Germany
| | - Franz Heppt
- Department of Dermatology, Deutsches Zentrum Immuntherapie (DZI), Universitätsklinikum Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (A.W.); (T.S.); (F.H.); (A.H.); (M.D.K.); (E.A.T.K.); (F.T.); (M.E.); (C.B.)
- Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN), 91054 Erlangen, Germany
| | - Annkathrin Hornung
- Department of Dermatology, Deutsches Zentrum Immuntherapie (DZI), Universitätsklinikum Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (A.W.); (T.S.); (F.H.); (A.H.); (M.D.K.); (E.A.T.K.); (F.T.); (M.E.); (C.B.)
- Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN), 91054 Erlangen, Germany
| | - Matthias D. Kaufmann
- Department of Dermatology, Deutsches Zentrum Immuntherapie (DZI), Universitätsklinikum Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (A.W.); (T.S.); (F.H.); (A.H.); (M.D.K.); (E.A.T.K.); (F.T.); (M.E.); (C.B.)
- Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN), 91054 Erlangen, Germany
| | - Elias A. T. Koch
- Department of Dermatology, Deutsches Zentrum Immuntherapie (DZI), Universitätsklinikum Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (A.W.); (T.S.); (F.H.); (A.H.); (M.D.K.); (E.A.T.K.); (F.T.); (M.E.); (C.B.)
- Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN), 91054 Erlangen, Germany
| | - Frédéric Toussaint
- Department of Dermatology, Deutsches Zentrum Immuntherapie (DZI), Universitätsklinikum Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (A.W.); (T.S.); (F.H.); (A.H.); (M.D.K.); (E.A.T.K.); (F.T.); (M.E.); (C.B.)
- Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN), 91054 Erlangen, Germany
| | - Michael Erdmann
- Department of Dermatology, Deutsches Zentrum Immuntherapie (DZI), Universitätsklinikum Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (A.W.); (T.S.); (F.H.); (A.H.); (M.D.K.); (E.A.T.K.); (F.T.); (M.E.); (C.B.)
- Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN), 91054 Erlangen, Germany
| | - Carola Berking
- Department of Dermatology, Deutsches Zentrum Immuntherapie (DZI), Universitätsklinikum Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (A.W.); (T.S.); (F.H.); (A.H.); (M.D.K.); (E.A.T.K.); (F.T.); (M.E.); (C.B.)
- Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN), 91054 Erlangen, Germany
| | - Markus V. Heppt
- Department of Dermatology, Deutsches Zentrum Immuntherapie (DZI), Universitätsklinikum Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (A.W.); (T.S.); (F.H.); (A.H.); (M.D.K.); (E.A.T.K.); (F.T.); (M.E.); (C.B.)
- Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN), 91054 Erlangen, Germany
- Correspondence: ; Tel.: +49-9131-85-35747
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Leiter U, Gutzmer R, Alter M, Ulrich C, Meiwes A, Heppt MV, Steeb T, Berking C, Lonsdorf AS, Sachse MM, Garbe C, Hillen U. [Cutaneous squamous cell carcinoma]. Hautarzt 2020; 71:597-606. [PMID: 32583034 DOI: 10.1007/s00105-020-04620-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Cutaneous squamous cell carcinoma (cSCC) is one of the most common cancers of the Caucasian population and accounts for 20% of all skin tumours. An S3 guideline of the German Guideline Program in Oncology has been available since 2019. The diagnosis is based on the clinical examination. Excision and histological confirmation is required for all clinically suspicious lesions to allow prognostic assessment and correct treatment. The therapy of first choice is complete excision with histological control of the surgical margin. In cSCC with risk factors such as tumor thickness >6 mm, sentinel lymph node biopsy may be discussed, but there is currently no clear evidence of its prognostic and therapeutic relevance. Adjuvant radiation therapy may be considered in cases of high risk of recurrence and should be tested in cases of inoperable tumors. The indication for electrochemotherapy should also be considered in the treatment of local or locoregional recurrence. The immune checkpoint inhibitor cemiplimab is approved for the treatment of inoperable or metastasized cSCC. In case of contraindications, chemotherapeutic agents, epidermal growth factor receptor (EGFR) inhibitors or palliative radiotherapy can be used. Since the evidence is low in these cases, a systemic therapy should be used preferentially within clinical studies. Follow-up care should be risk-adapted and includes a dermatological control, supplemented by ultrasound examinations in high-risk patients.
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Affiliation(s)
- U Leiter
- Zentrum für Dermato-Onkologie, Südwestdeutsches Tumorzentrum, Universitäts-Hautklinik, Eberhard-Karls-Universität, Liebermeisterstr. 25, 72076, Tübingen, Deutschland.
| | - R Gutzmer
- Hauttumorzentrum Hannover, Klinik für Dermatologie, Allergologie und Venerologie, Medizinische Hochschule Hannover, Hannover, Deutschland
| | - M Alter
- Universitätshautklinik, Otto-von-Guericke-Universität Magdeburg, Magdeburg, Deutschland
| | - C Ulrich
- Klinik für Dermatologie, Venerologie und Allergologie, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - A Meiwes
- Zentrum für Dermato-Onkologie, Südwestdeutsches Tumorzentrum, Universitäts-Hautklinik, Eberhard-Karls-Universität, Liebermeisterstr. 25, 72076, Tübingen, Deutschland
| | - M V Heppt
- Hautklinik, Universitätsklinikum Erlangen, Comprehensive Cancer Center Erlangen - Europäische Metropolregion Nürnberg, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Deutschland
| | - T Steeb
- Hautklinik, Universitätsklinikum Erlangen, Comprehensive Cancer Center Erlangen - Europäische Metropolregion Nürnberg, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Deutschland
| | - C Berking
- Hautklinik, Universitätsklinikum Erlangen, Comprehensive Cancer Center Erlangen - Europäische Metropolregion Nürnberg, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Deutschland
| | - A S Lonsdorf
- Universitäts-Hautklinik Heidelberg, Ruprecht-Karls-Universität Heidelberg, Heidelberg, Deutschland
| | - M M Sachse
- Klinik für Dermatologie, Allergologie und Phlebologie, Klinikum Bremerhaven, Bremerhaven, Deutschland
| | - C Garbe
- Zentrum für Dermato-Onkologie, Südwestdeutsches Tumorzentrum, Universitäts-Hautklinik, Eberhard-Karls-Universität, Liebermeisterstr. 25, 72076, Tübingen, Deutschland
| | - U Hillen
- Klinik für Dermatologie und Venerologie, Vivantes Klinikum Neukölln, Berlin, Deutschland
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Steeb T, Wessely A, von Bubnoff D, Dirschka T, Drexler K, Falkenberg C, Hassel JC, Hayani K, Hüning S, Kähler KC, Karrer S, Krammer C, Leiter U, Lill D, Marsela E, Meiwes A, Nashan D, Nasifoglu S, Schmitz L, Sirokay J, Thiem A, Utikal J, Zink A, Berking C, Heppt MV. Treatment Motivations and Expectations in Patients with Actinic Keratosis: A German-Wide Multicenter, Cross-Sectional Trial. J Clin Med 2020; 9:jcm9051438. [PMID: 32408601 PMCID: PMC7290787 DOI: 10.3390/jcm9051438] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 05/07/2020] [Accepted: 05/08/2020] [Indexed: 01/02/2023] Open
Abstract
Patient-centered motives and expectations of the treatment of actinic keratoses (AK) have received little attention until now. Hence, we aimed to profile and cluster treatment motivations and expectations among patients with AK in a nationwide multicenter, cross-sectional study including patients from 14 German skin cancer centers. Patients were asked to complete a self-administered questionnaire. Treatment motives and expectations towards AK management were measured on a visual analogue scale from 1-10. Specific patient profiles were investigated with subgroup and correlation analysis. Overall, 403 patients were included. The highest motivation values were obtained for the items "avoid transition to invasive squamous cell carcinoma" (mean ± standard deviation; 8.98 ± 1.46), "AK are considered precancerous lesions" (8.72 ± 1.34) and "treating physician recommends treatment" (8.10 ± 2.37; p < 0.0001). The highest expectation values were observed for the items "effective lesion clearance" (8.36 ± 1.99), "safety" (8.20 ± 2.03) and "treatment-related costs are covered by health insurance" (8.00 ± 2.41; p < 0.0001). Patients aged ≥77 years and those with ≥7 lesions were identified at high risk of not undergoing any treatment due to intrinsic and extrinsic motivation deficits. Heat mapping of correlation analysis revealed four clusters with distinct motivation and expectation profiles. This study provides a patient-based heuristic tool for a personalized treatment decision in patients with AK.
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Affiliation(s)
- Theresa Steeb
- Department of Dermatology, Universitätsklinikum Erlangen, Friedrich-Alexander-University of Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (T.S.); (A.W.); (C.B.)
- Department of Dermatology and Allergy, University Hospital, LMU Munich, 80337 Munich, Germany; (K.H.); (C.K.); (D.L.); (E.M.); (S.N.)
- Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN), 91054 Erlangen, Germany
| | - Anja Wessely
- Department of Dermatology, Universitätsklinikum Erlangen, Friedrich-Alexander-University of Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (T.S.); (A.W.); (C.B.)
- Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN), 91054 Erlangen, Germany
| | - Dagmar von Bubnoff
- Department of Dermatology, University Hospital Schleswig-Holstein Campus Lübeck, 23562 Lübeck, Germany;
| | | | - Konstantin Drexler
- Department of Dermatology, University Hospital Regensburg, 93042 Regensburg, Germany; (K.D.); (S.K.)
| | | | - Jessica C. Hassel
- Section of Dermatooncology, Department of Dermatology and National Center for Tumor Diseases, 69120 Heidelberg, Germany;
| | - Kinan Hayani
- Department of Dermatology and Allergy, University Hospital, LMU Munich, 80337 Munich, Germany; (K.H.); (C.K.); (D.L.); (E.M.); (S.N.)
| | - Svea Hüning
- Department of Dermatology, Hospital of Dortmund, 44137 Dortmund, Germany; (S.H.); (D.N.)
| | - Katharina C. Kähler
- Department of Dermatology, University Hospital Schleswig-Holstein Campus Kiel, 24105 Kiel, Germany;
| | - Sigrid Karrer
- Department of Dermatology, University Hospital Regensburg, 93042 Regensburg, Germany; (K.D.); (S.K.)
| | - Christian Krammer
- Department of Dermatology and Allergy, University Hospital, LMU Munich, 80337 Munich, Germany; (K.H.); (C.K.); (D.L.); (E.M.); (S.N.)
| | - Ulrike Leiter
- Department of Dermatology, Center for Dermatooncology, University Hospital Tübingen, 72076 Tübingen, Germany; (U.L.); (A.M.)
| | - Diana Lill
- Department of Dermatology and Allergy, University Hospital, LMU Munich, 80337 Munich, Germany; (K.H.); (C.K.); (D.L.); (E.M.); (S.N.)
| | - Enklajd Marsela
- Department of Dermatology and Allergy, University Hospital, LMU Munich, 80337 Munich, Germany; (K.H.); (C.K.); (D.L.); (E.M.); (S.N.)
| | - Andreas Meiwes
- Department of Dermatology, Center for Dermatooncology, University Hospital Tübingen, 72076 Tübingen, Germany; (U.L.); (A.M.)
| | - Dorothée Nashan
- Department of Dermatology, Hospital of Dortmund, 44137 Dortmund, Germany; (S.H.); (D.N.)
| | - Suzan Nasifoglu
- Department of Dermatology and Allergy, University Hospital, LMU Munich, 80337 Munich, Germany; (K.H.); (C.K.); (D.L.); (E.M.); (S.N.)
| | - Lutz Schmitz
- Department of Dermatology, Skin Cancer Center, Ruhr University Bochum, 44801 Bochum, Germany;
| | - Judith Sirokay
- Department of Dermatology and Allergy, University Hospital of Bonn, 53127 Bonn, Germany;
| | - Alexander Thiem
- Clinic for Dermatology and Venereology, University Medical Center Rostock, 18057 Rostock, Germany;
| | - Jochen Utikal
- Skin Cancer Unit, German Cancer Research Center (DKFZ) and Department of Dermatology, Venereology and Allergology, University Medical Center Mannheim, Ruprecht-Karl University of Heidelberg, 68167 Mannheim, Germany;
| | - Alexander Zink
- Department of Dermatology and Allergy, Technical University of Munich, 80802 Munich, Germany;
| | - Carola Berking
- Department of Dermatology, Universitätsklinikum Erlangen, Friedrich-Alexander-University of Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (T.S.); (A.W.); (C.B.)
- Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN), 91054 Erlangen, Germany
| | - Markus V. Heppt
- Department of Dermatology, Universitätsklinikum Erlangen, Friedrich-Alexander-University of Erlangen-Nürnberg (FAU), 91054 Erlangen, Germany; (T.S.); (A.W.); (C.B.)
- Comprehensive Cancer Center Erlangen-European Metropolitan Area of Nuremberg (CCC ER-EMN), 91054 Erlangen, Germany
- Correspondence: ; Tel.: +49-9131-85-35747
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